局解手术学杂志2023，Vol.32Issue(12)：1068-1071,4.DOI:10.11659/jjssx.05E023069
胸椎旁神经阻滞保留自主呼吸麻醉对老年胸腔镜手术患者术中脑氧合和术后谵妄的影响
Effects of thoracic paravertebral nerve block combined with preserved spontaneous respiratory anesthesia on intraoperative cerebral oxygenation and postoperative delirium in elderly patients undergoing thoracoscopic surgery
摘要
Abstract
Objective To observe the effects of thoracic paravertebral nerve block(TPVB)combined with preserved spontaneous respiratory anesthesia on intraoperative local cerebral oxygen saturation(SrcO2)and postoperative delirium(POD)in elderly patients undergoing thoracoscopic surgery.Methods A total of 80 elderly patients who planned to undergo thoracoscopic wedge resection of lung were randomly divided into the control group and the observation group,and finally 76 patients completed the study,with 39 cases in the control group and 37 cases in the observation group.The control group was given general anesthesia under single lung ventilation,while the observation group was given TPVB combined with preserved spontaneous respiratory anesthesia.Patients'SrcO2 was monitored by a near infrared spectrometer,and the decrease of SrcO2 from baseline by≥10%was considered as cerebral oxygen desaturation(COD).The preoperative baseline value of SrcO2,intraoperative lowest value of SrcO2,the incidence and duration of COD of the two groups were compared.The operation situation,the incidence of hypotension,hypoxemia,delayed awakening and analgesic recovery rate were counted.The incidence of POD and pain visual analogue scale(VAS)score 2 hours,24 hours and 72 hours after surgery were evaluated.The hospitalization time was recorded,and the quality of recovery-40(QoR-40)scores at admission and discharge were evaluated.Results There was no significant difference in operative time,intraoperative blood loss,preoperative baseline value of SrcO2,VAS score 2 hours after surgery and QoR-40 score at admission between the two groups(P>0.05).Compared with the control group,the observation group had higher intraoperative lowest value of SrcO2(P<0.05),lower incidence and shorter duration of COD(P<0.05),lower incidence of POD 2 hours,24 hours and 72 hours after surgery(P<0.05),lower VAS scores 24 hours and 72 hours after surgery and analgesic recovery rate(P<0.05),lower/shorter incidence of intraoperative hypotension,delayed awakening and hospitalization time(P<0.05),and higher QoR-40 scores at discharge(P<0.05).Conclusion TPVB combined with preserved spontaneous respiratory anesthesia can improve the level of cerebral oxygenation and reduce the occurrence of POD in elderly patients undergoing thoracoscopic surgery.关键词
胸椎旁神经阻滞/自主呼吸/麻醉/胸腔镜/术后谵妄/局部脑氧饱和度/老年Key words
thoracic paravertebral nerve block/spontaneous respiration/anesthesia/thoracoscope/postoperative delirium/local cere-bral oxygen saturation/elderly分类
医药卫生引用本文复制引用
许鑫,张燕,谢红梅..胸椎旁神经阻滞保留自主呼吸麻醉对老年胸腔镜手术患者术中脑氧合和术后谵妄的影响[J].局解手术学杂志,2023,32(12):1068-1071,4.基金项目
联勤保障部队第九〇〇医院院级项目(2022MS04) （2022MS04）
