胸椎旁神经阻滞复合静脉全麻对老年肺癌手术患者血清S100β、NSE水平和认知功能的影响

Effects of thoracic paravertebral nerve block combined with intravenous general anesthesia on serum S100β,NSE levels and cognitive function in elderly patients with lung cancer undergoing surgery

目的探讨胸椎旁神经阻滞复合静脉全麻对老年肺癌手术患者血清中枢脑神经蛋白(S100β)、神经元特异性烯醇化酶(NSE)水平和认知功能的影响。方法选取2022年1月至2023年5月在金华市中心医院进行肺癌根治术治疗的98例老年患者,按照随机数字表法分为观察组和对照组,每组49例,对照组采取静脉全麻,观察组采取胸椎旁神经阻滞复合静脉全麻。比较两组麻醉情况、血流动力学、血清S100β、NSE水平、认知功能和疼痛评分,以及不良反应发生情况。结果观察组患者的自主呼吸恢复时间、拔管时间短于对照组,丙泊酚、舒芬太尼用量、镇痛按压次数均少于对照组,差异均有统计学意义(t分别=2.36、2.77、3.08、3.29、9.51,P均<0.05)。在插管时(T0),观察组心率(HR)低于对照组,平均动脉压(MAP)高于对照组(t分别=-2.49、2.33,P均<0.05);在T1时,观察组HR低于对照组,MAP水平高于对照组(t分别=-8.25、4.42,P均<0.05);在切皮后30 min(T2)时,观察组HR、MAP、氧饱和度(SpO2)低于对照组(t分别=-8.60、-3.65、-2.43,P均<0.05);在术毕进入麻醉监测室15 min(T3)时,观察组HR、SpO2低于对照组,MAP高于对照组(t分别=-2.24、-2.45、4.63,P均<0.05)。术后12、24 h,观察组血清S100β和NSE水平低于对照组(t分别=-2.24、-2.32、-3.15、-2.14,P均<0.05);术后6、12、24 h,观察组简易精神状态量表(MMSE)评分高于对照组,疼痛视觉模拟(VAS)评分低于对照组,差异均有统计学意义(t分别=2.60、3.06、3.05、-8.99、-9.49、-8.99,P均<0.05)。观察组患者不良反应发生率低于对照组,差异有统计学意义(χ^(2)=4.34,P<0.05)。结论老年肺癌手术患者应用胸椎旁神经阻滞复合静脉全麻能有效稳定血流动力学指标,改善血清S100β、NSE水平,减小对认知功能的影响,镇痛效果较好且不良反应较少。

Objective To investigate the effects of thoracic paravertebral nerve block combined with intravenous gener-al anesthesia on serum levels of person S100βperotein(S100β),neuron-specific enolase(NSE)and cognitive function in elderly patients undergoing surgery for lung cancer.Methods A total of 98 elderly patients who underwent radical lung cancer surgery at Jinhua Municipal Central Hospital from January 2022 to May 2023 were selected and randomly di-vided into an observation group and a control group,with 49 patients in each group.The control group received intrave-nous general anesthesia,while the observation group received thoracic paravertebral nerve block combined with intrave-nous general anesthesia.The anesthesia situation,hemodynamics,serum S100β,NSE level,cognitive function,pain score,and incidence of adverse reactions were compared between two groups.Results The spontaneous breathing recovery time and extubation time of the observation group patients were shorter than those of the control group,and the dosage of propofol and sufentanil,as well as the number of analgesic compressions,were all lower than those of the control group,with statistical significance(t=2.36,2.77,3.08,3.29,9.51,P<0.05).At intubation(T0),the HR of the observation group was lower than that of the control group,while the MAP was higher than that of the control group(t=-2.49,2.33,P<0.05).At T1,the HR of the observa⁃tion group was lower than that of the control group,while the MAP level was higher than that of the control group(t=-8.25,4.42,P<0.05).At 30 minutes after skin cutting(T2),the HR,MAP,and SpO2 in the observation group were lower than those in the control group(t=-8.60,-3.65,-2.43,P<0.05).At the anesthesia monitoring room for 15 minutes(T3)after surgery,the HR and SpO2 in the observa⁃tion group were lower than those in the control group,while the MAP was higher than that in the control group(t=-2.24,-2.45,4.63,P<0.05).At 12 hours and 24 hours after surgery,the serum S100βand NSE levels in the observa⁃tion group were lower than those in the control group(t=-2.24,-2.32,-3.15,-2.14,P<0.05).At 6 hours,12 hours,and 24 hours after surgery,the MMSE score in the observation group was higher that in the control group,while the VAS score was lower than that in the control group(t=2.60,3.06,3.05,-8.99,-9.49,-8.99,P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,and the difference was statistically significant(χ^(2)=4.34,P<0.05).Conclusion The application of thoracic nerve block combined with intravenous gener⁃al anesthesia in elderly patients undergoing surgery for lung cancer effectively stabilizes hemodynamic indexes,improves serum S100βand NSE levels,reduces the impact on cognitive function,has better analgesic effect and less adverse re⁃actions.