右美托咪定联合超声引导下胸椎旁神经阻滞对上腹部手术患者应激和认知功能障碍的影响

摘要/Abstract

摘要： 目的：观察右美托咪定联合超声引导下胸椎旁神经阻滞对上腹部手术患者应激和认知功能障碍的影响。方法：选择2018年1月至2019年12月在我院行上腹部手术治疗的患者116例，根据随机数字方法将患者分为观察组和对照组，每组各58例。对照组采用超声引导下胸椎旁神经阻滞，观察组在对照组的基础上采用右美托咪定联合超声引导下胸椎旁神经阻滞。观察麻醉前（T0）、麻醉后（T1）、手术切皮时（T2）和苏醒时（T3）各时点两组的血流动力学指标[心率（HR），平均血压（MAP）和血氧饱和度（SpO2）]和炎症应激指标[磷脂酰肌醇-3激酶（PI3K），内皮素-1（ET-1），去甲肾上腺素（NE）和皮质醇（Cor）]水平的变化，麻醉前后两组的认知相关指标[中枢神经特异蛋白（S100-β），脂联素（ADP），简易智力状态量表（MMSE）和韦氏记忆量表（WMS）评分]的变化，比较两组术后情况。结果：观察组在T1、T2和T3时点的HR水平较麻醉前和对照组降低（P<0.01），而两组在各个时点的MAP和SpO2水平差异无统计学意义（P>0.05）。两组的各个时点PI3K，ET-1，NE和Cor水平较麻醉前升高（P<0.01），而对照组的升高水平较观察组更多（P<0.01）。两组麻醉前S100-β，ADP，MMSE和WMS评分水平差异无统计学意义（P>0.05），麻醉后两组S100-β水平高于麻醉前，ADP、MMSE和WMS评分水平较麻醉前降低（P<0.01），而对照组的升高或者降低水平比观察组更明显（P<0.01）。两组术后的呼吸恢复时间、睁眼时间、拔管时间、嗜睡率和眩晕率差异无统计学意义（P>0.05），而观察组的恶心呕吐和呼吸抑制发生率低于对照组（P<0.01）。结论：右美托咪定联合超声引导下胸椎旁神经阻滞对上腹部手术有利于血液动力学的稳定，能够缓解机体的应激反应和缓解术后的认识功能障碍。

关键词: font-size:medium, ">右美托咪定；胸椎旁神经阻滞；应激；认知功能障碍；麻醉

Abstract: Objective： To observe the effects of dexmedetomidine combined with ultrasound-guided thoracic paravertebral nerve block on stress and cognitive dysfunction in patients undergoing upper abdominal surgery. Methods： 116 patients who underwent upper abdominal surgery in our hospital from January 2018 to December 2019 were divided into the observation group and the control group according to random number method， with 58 cases in each group. The control group patients underwent ultrasound-guided thoracic paravertebral nerve block. The observation group patients were treated with dexmedetomidine combined with ultrasound-guided thoracic paravertebral nerve block on the basis of the control group. The hemodynamic index [heart rate (HR)， mean blood pressure (MAP) and blood oxygen saturation (SpO2) ] and inflammation stress index [phospholipid inositol 3 kinase (PI3K)， endothelin-1 (ET-1)， norepinephrine (NE) and cortisol (Cor)] were detected at the time point of pre-anesthesia (T0)， post-anesthesia (T1)， surgical incision (T2) and waking (T3)， and the cognitive related index [S100-β， adiponectin (ADP)， MMSE and WMS] were also observed before and after anesthesia. The postoperative conditions were compared between the two groups. Results： The HR levels in the observation group at T1， T2 and T3 were lower than those before anesthesia and those in the control group (P<0.01)， but there was no significant difference in MAP and SpO2 between the two groups at each time point (P>0.05). The levels of PI3K， ET-1， NE and Cor at each time point in the two groups were higher than those before anesthesia (P<0.01)， while the elevated levels in control group were more than those in the observation group (P<0.01). There were no significant differences in S100-β， ADP， MMSE and WMS scores between the two groups before anesthesia (P>0.05). The levels of S100-β in the two groups after anesthesia were higher than those before anesthesia， and the ADP levels， MMSE and WMS scores were lower than those before anesthesia (P<0.01)， while the elevation or decrease levels in the observation group were lower than those in the control group (P<0.01). There was no significant difference in postoperative respiratory recovery time， blink time， extubation time， sleepiness and dizziness rate between the two groups (P>0.05)， while the incidence of nausea， vomiting and respiratory depression were lower in the control group than those in the observation group (P<0.01). Conclusion： Dexm medetomidine combined with ultrasound-guided thoracic paravertebral nerve block is beneficial to hemodynamic stability in upper abdominal surgery， which can alleviate the body's stress response and relieve postoperative cognitive dysfunction.

Key words: font-size:medium, ">Dexmedetomidine； Thoracic paravertebral nerve block； Stress； Cognitive dysfunction； Anesthesia

中图分类号:

朱海峰, 周懿之, 曾真. 右美托咪定联合超声引导下胸椎旁神经阻滞对上腹部手术患者应激和认知功能障碍的影响[J]. 中国医药导刊, 2020, 22(4): 237-242.

ZHU Haifeng, ZHOU Yizhi, ZENG Zhen. Effects of Dexmedetomidine Combined with Ultrasound-guided Thoracic Paravertebral Nerve Block on Stress and Cognitive Dysfunction in Patients Undergoing#br# Upper Abdominal Surgery[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2020, 22(4): 237-242.

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