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

许鑫; 张燕; 谢红梅

doi:10.11659/jjssx.05E023069

您当前的位置：

首页 >

文章列表页 >

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

临床研究 | 更新时间：2023-12-13

- 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
- 局解手术学杂志 2023年32卷第12期页码：1068-1071
- 作者机构：
  
  联勤保障部队第九〇〇医院麻醉科，福建福州 350000
- 作者简介：
  
  谢红梅，E-mail：xiehongmeifzh@126.com
- 基金信息：
  
  联勤保障部队第九〇〇医院院级项目(2022MS04)
- DOI：10.11659/jjssx.05E023069
  中图分类号： R614
- 纸质出版日期：2023-12-25，
  
  收稿日期：2023-05-15，
扫描看全文
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.

XU Xin,ZHANG Yan,XIE Hong-mei.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[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(12):1068-1071.
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. DOI： 10.11659/jjssx.05E023069.

XU Xin,ZHANG Yan,XIE Hong-mei.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[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(12):1068-1071. DOI： 10.11659/jjssx.05E023069.

摘要

目的

观察胸椎旁神经阻滞（TPVB）保留自主呼吸麻醉对老年胸腔镜手术患者术中局部脑氧饱和度（S

）和术后谵妄（POD）的影响。

方法

将80例拟择期行胸腔镜下肺楔形切除术的老年患者随机分成对照组和观察组，最终76例患者完成研究，其中对照组39例，观察组37例。对照组采用单肺通气下全身麻醉，观察组采用TPVB保留自主呼吸麻醉。通过近红外光谱仪监测患者S

，以S

较基线下降≥10%为脑局部氧合不足（COD）。比较2组术前S

基线值，术中S

最低值，COD发生率及其持续时间；统计手术情况及术中低血压、低血氧、苏醒延迟发生率、镇痛补救率；评估术后2 h、24 h和72 h的POD发生率和疼痛视觉模拟量表（VAS）评分；记录住院时间，并评估入院和出院时的40项恢复质量评分量表（QoR-40）评分。

结果

2组患者手术时间、术中出血量、术前S

基线值、术后2 h的VAS评分和入院时的QoR-40评分比较差异无统计学意义（

0.05）。与对照组比较，观察组术中S

最低值更高（

0.05），COD发生率更低、持续时间更短（

0.05），术后2 h、24 h、72 h的POD发生率更低（

0.05），术后24 h、72 h的VAS评分以及镇痛补救率更低（

0.05），术中低血压发生率、苏醒延迟发生率和住院时间均更低/短（

0.05），且出院时的QoR-40评分更高（

0.05）。

结论

TPVB保留自主呼吸麻醉可改善老年胸腔镜手术患者术中脑氧合水平，减少POD的发生。

Abstract

Objective

To observe the effects of thoracic paravertebral nerve block （TPVB） combined with preserved spontaneous respiratory anesthesia on intraoperative local cerebral oxygen saturation （S

） 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' S

was monitored by a near infrared spectrometer， and the decrease of S

from baseline by ≥10% was considered as cerebral oxygen desaturation （COD）. The preoperative baseline value of S

， intraoperative lowest value of S

， 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 S

， VAS score 2 hours after surgery and QoR-40 score at admission between the two groups （

0.05）. Compared with the control group， the observation group had higher intraoperative lowest value of S

（

0.05）， lower incidence and shorter duration of COD （

0.05）， lower incidence of POD 2 hours， 24 hours and 72 hours after surgery （

0.05）， lower VAS scores 24 hours and 72 hours after surgery and analgesic recovery rate （

0.05）， lower/shorter incidence of intraoperative hypotension， delayed awakening and hospitalization time （

0.05）， and higher QoR-40 scores at discharge （

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

Keywords

thoracic paravertebral nerve blockspontaneous respirationanesthesiathoracoscopepostoperative deliriumlocal cerebral oxygen saturationelderly

references

O'Hanlon S，Baxter M，Hosie A.Postoperative delirium in older patients with cancer：the role of psychological distress and social support［J］.Curr Opin Support Palliat Care，2022，16（1）：38-47.doi： 10.1097/ SPC.0000000000000588http://dx.doi.org/10.1097/SPC.0000000000000588.

Cui F，Zhao W，Mu DL，et al.Association between cerebral desaturation and postoperative delirium in thoracotomy with one-lung ventilation：a prospective cohort study［J］.Anesth Analg，2021，133（1）：176-186.doi： 10.1213/ANE.0000000000005489http://dx.doi.org/10.1213/ANE.0000000000005489.

李凯，杨亮亮，刘仲祥，等.保留自主呼吸的非气管插管麻醉在胸腔镜手术中的应用进展［J］.中国实验诊断学，2019，23（11）：2028-2031.doi：10.3969/j.issn.1007-4287.2019.11.051http://dx.doi.org/10.3969/j.issn.1007-4287.2019.11.051.

滕培兰，徐德荣，吕菲，等.以脑氧饱和度为导向的肺保护性通气策略对老年患者胸腔镜肺癌根治术后谵妄的影响［J］.临床麻醉学杂志，2020，36（10）：1009-1012.doi：10.12089/jca.2020.10.017http://dx.doi.org/10.12089/jca.2020.10.017.

李娟，邹义壮，冯锋，等.谵妄评定方法修订及其信度、效度测试［J］.临床精神医学杂志，2003（3）：147-149.doi：10.3969/j.issn.1005-3220.2003.03.009http://dx.doi.org/10.3969/j.issn.1005-3220.2003.03.009.

Feng M，Wang L，Sun J，et al.Thoracic paravertebral block combined with general anaesthesia or general anaesthesia alone for thoracoscopic lung adenocarcinoma surgery： a retrospective study［J］.Cancer Manag Res，2022，14：953-965.doi：10.2147/CMAR.S346285http://dx.doi.org/10.2147/CMAR.S346285.

Marchant BE，Miller SA，Royster RL.Cerebral desaturation and one-lung ventilation［J］.J Cardiothorac Vasc Anesth，2021，35（2）：551-554.doi：10.1053/j.jvca.2020.09.098http://dx.doi.org/10.1053/j.jvca.2020.09.098.

He KQ，Wang S，Zhang W，et al.What is the impact of perioperative cerebral oxygen desaturation on postoperative delirium in old population： a systemic review and meta-analysis［J］.Aging Clin Exp Res，2022，34（8）：1761-1770.doi：10.1007/s40520-022-02128-6http://dx.doi.org/10.1007/s40520-022-02128-6.

Ding L，Chen DX，Li Q.Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders：a systematic review and meta-analysis［J］.Bmc Anesthesiol，2020，20（1）：254.doi：10.1186/s12871-020-01163-yhttp://dx.doi.org/10.1186/s12871-020-01163-y.

Fabo C，Oszlanyi A，Lantos J，et al.Non-intubated thoracoscopic Surgery-Tips and tricks from anesthesiological aspects： a mini review［J］.Front Surg，2021，8：818456.doi：10.3389/fsurg.2021.818456http://dx.doi.org/10.3389/fsurg.2021.818456.

Huang Y，Bo Y，Li Y，et al.The impact of tubeless anesthesia versus intubated anesthesia on cerebral oxygen saturation and postoperative cognitive function in patients undergoing video-assisted thoracoscopic surgery：a randomized trial［J］.J Thorac Dis，2022，14（10）：4012-4030.doi：10.21037/jtd-22-1165http://dx.doi.org/10.21037/jtd-22-1165.

张欢欢，孟璐，姚晶曼，等.胸椎旁神经阻滞复合保留自主呼吸的非气管插管麻醉在胸腔镜手术中应用的临床分析［J］.现代医学，2022，50（1）：70-74.doi：10.3969/j.issn.1671-7562.2022. 01.013http://dx.doi.org/10.3969/j.issn.1671-7562.2022.01.013.

Licker M，Hagerman A，Jeleff A，et al.The hypoxic pulmonary vasoconstriction： from physiology to clinical application in thoracic surgery［J］.Saudi J Anaesth，2021，15（3）：250-263.doi：10.4103/sja.sja_1216_20http://dx.doi.org/10.4103/sja.sja_1216_20.

黄璜，李萌萌，孟令超，等.麻醉诱导后低血压对机体组织氧饱和度的影响［J］.北京医学，2022，44（3）：249-252.doi：10.15932/j.0253-9713.2022.03.012http://dx.doi.org/10.15932/j.0253-9713.2022.03.012.

郭庆聪，袁淑贞，何炳华.超声引导下连续胸椎旁神经阻滞复合全麻对老年开胸手术患者血流动力学和应激反应的影响［J］.广东医学，2018（s1）：93-96.doi：10.13820/j.cnki.gdyx.2018.s1.031http://dx.doi.org/10.13820/j.cnki.gdyx.2018.s1.031.

Ding X，Gao X，Chen Q，et al.Preoperative acute pain is associated with postoperative delirium［J］.Pain Med，2021，22（1）：15-21.doi： 10.1093/pm/pnaa314http://dx.doi.org/10.1093/pm/pnaa314.

鲁清，程元骏，周孟虎.前锯肌平面阻滞和胸椎旁神经阻滞在胸腔镜手术中的麻醉效果及对疼痛因子的影响［J］.中国现代医学杂志，2023，33（3）：87-92.doi：10.3969/j.issn.1005-8982. 2023.03.014http://dx.doi.org/10.3969/j.issn.1005-8982.2023.03.014.

王明霞，张金源，廖丽君，等.胸椎旁连续输注亚甲蓝阻滞液治疗胸段带状疱疹后神经痛的疗效观察［J］.中国疼痛医学杂志，2021，27（8）：591-595.doi：10.3969/j.issn.1006-9852. 2021. 08.006http://dx.doi.org/10.3969/j.issn.1006-9852.2021.08.006.

Zhang Q，Xu F，Xuan D，et al.Risk factors for delayed recovery in post-anesthesia care unit after surgery：a large and retrospective cohort study［J］.Int J Surg，2023，109（5）： 1281-1290.doi：10.1097/JS9.0000000000000364http://dx.doi.org/10.1097/JS9.0000000000000364.

廖金庆，卢清旺，黄琦萍，等.保留自主呼吸不插管麻醉在胸腔镜肺部手术中的应用［J］.中国微创外科杂志，2023，29（1）：3-7.doi：10.3969/j.issn.1009-6604.2023.01.002http://dx.doi.org/10.3969/j.issn.1009-6604.2023.01.002.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

艾司氯胺酮复合丙泊酚应用于无痛宫腔镜检查术中的麻醉效果

两种确定肺段间平面的胸腔镜精准肺段切除术的临床对照研究

老年营养不良患者全身麻醉下股骨近端防旋髓内钉内固定术中低体温因素分析

基于精准麻醉理念的靶控输注模式在心脏手术麻醉中的应用

老年结直肠癌术后胃肠功能障碍的影响因素及预测模型