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| 胸椎旁神经阻滞联合全麻对老年患者术后认知功能和血清MMP-9、ADP的影响 |
| Effects of thoracic paravertebral block combined with general anesthesia on postoperative cognitive function, serum MMP-9 and adiponectin of elderly patients undergoing thoracotomy |
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| DOI：10.12089/jca.2018.07.008 |
| 中文关键词: 胸椎旁神经阻滞 开胸手术 老年患者 术后认知功能障碍 基质金属蛋白酶-9 脂联素 |
| 英文关键词: Thoracic paravertebral block Thoracotomy Elderly Matrix metalloproteinase-9 Adiponectin Postoperative cognitive dysfunction |
| 基金项目:广东省东莞市社会科技发展(重点)项目(201750715001459);广东省医学科研基金项目(C2016044); |
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| 中文摘要: |
目的 探讨胸椎旁神经阻滞联合全麻对老年开胸手术患者术后认知功能和血清基质金属蛋白酶-9(MMP-9)、脂联素(ADP)的影响。
方法 选择在本院行开胸手术老年患者80例, 男52例, 女28例, 年龄65～80岁, BMI 18.6～26.6 kg/m2, ASA Ⅱ或Ⅲ级。采用简单随机抽样法分为两组：胸椎旁神经阻滞联合全麻组(PG组)和单纯全麻组(GA组), 每组40例。PG组采用连续胸椎旁神经阻滞联合全麻, GA组采用单纯全身麻醉。记录两组患者麻醉前即刻(T0)、诱导插管后(T1)、切皮后15 min(T2)、拔管前即刻(T3)的HR和MAP。采用酶联免疫吸附法于麻醉前即刻, 切皮后15 min、术后1和7 d分别采集静脉血样检测血清MMP-9、ADP浓度。采用MMSE于术前1 d和术后7 d对两组患者认知功能进行评估并记录。记录两组患者术后7 d POCD情况。
结果 与T0时比较, T2-T4时GA组HR明显增快、MAP明显升高(P<0.05)。与GA组比较, T2-T4时PG组HR明显减慢、MAP明显降低(P<0.05)。与麻醉前即刻比较, 切皮后15 min、术后1和7 d两组血清MMP-9浓度明显升高(P<0.05), ADP浓度明显降低(P<0.05)。与GA组比较, 切皮后15 min、术后1和7 d PG组血清MMP-9浓度明显降低(P<0.05), ADP浓度明显升高(P<0.05)。术后7 d PG组发生POCD 4例(10.8%), 明显低于GA组8例(22.2%)(P<0.05)。
结论 胸椎旁神经阻滞联合全麻能改善老年开胸手术患者早期术后认知功能, 该麻醉方式同时也可抑制MMP-9和促进ADP表达。 |
| 英文摘要: |
Objective To study the effects of thoracic paravertebral block combined with general anesthesia on postoperative cognitive function, serum MMP-9 and adiponectin (ADP) of elderly patients undergoing thoracotomy.
Methods Eighty elderly patients aged from 65 to 80 years undergoing pulmonary lobectomy in our hospital were selected, including 52 male patients and 28 female patients, whose BMI was 18.6-26.6 kg/m2 and ASA was Ⅱ or Ⅲ. Simple random sampling method was adopted to divide the patients into thoracic paravertebral block combined with general anesthesia group (group PG) and general anesthesia group (group GA), 40 cases in each. The group PG was treated with thoracic paravertebral block combined with general anesthesia and the group GA was treated with general anesthesia. HR and MAP of the patients of the two groups before anesthesia (T0), after rapid sequence intubation (T1), 15 minutes after skin incision (T2) and before extubation (T3) were recorded. Venous blood samples were collected by enzyme-linked immunosorbent assay before anesthesia induction, 15 min after skin incision, and 1 day and 7 days after operation respectively, serum MMP-9 and ADP were also detected. MMSE was adopted to assess and record the cognitive functions of the patients of the two groups 1 day before operation and 7 days after operation. The incidence of POCD of the patients of the two groups 7 days after the operation was recorded.
Results Compared with that before anesthesia (T0), HR of the group GA accelerated significantly and MAP increased significantly from T2 to T4 (P<0.05). From T2 to T4, HR of the group PG was obviously slower and its MAP was significantly lower than that of the group GA (P<0.05). Compared with that before anesthesia induction, the concentration of serum MMP-9 of the two groups increased significantly 15 min after skin incision, 1 day and 7 days after operation (P<0.05) while the concentration of ADP decreased significantly (P<0.05). Compared with that of the group GA, the concentration of serum MMP-9 of the group PG decreased significantly 15 min after skin incision, 1 day and 7 days after operation (P<0.05), while that of ADP increased significantly (P<0.05). 4 cases developed POCD in the group PG (10.8%) 7 days after operation, which was significantly lower than that in the GA group (8 cases, 22.2%) (P<0.05).
Conclusion Thoracic paravertebral block combined with general anesthesia can improve the postoperative cognitive functions of elderly patients undergoing thoracotomy, since it inhibits MMP-9 and promotes of ADP expression and secretion. |
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