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| 腰方肌阻滞对老年患者腹腔镜直肠癌根治术后谵妄的影响 |
| Effect of quadratus lumborum block combined with general anesthesia on postoperative delirium in elderly patients undergoing laparoscopic radical resection of rectal cancer |
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| DOI：10.12089/jca.2018.07.015 |
| 中文关键词: 腰方肌阻滞 老年 腹腔镜直肠癌根治术 术后谵妄 |
| 英文关键词: Quadratus lumborum block Elderly patients Laparoscopic radical resection of rectal cancer Postoperative delirium |
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| 中文摘要: |
目的 探讨腰方肌阻滞对老年患者腹腔镜直肠癌根治术后谵妄的影响。
方法 选择本院择期拟行腹腔镜直肠癌根治术的老年患者240例, 男148例, 女92例, 年龄65～80岁, 体重45～85 kg, ASA Ⅰ 或 Ⅱ级, 采用随机数字表法分为两组: 腰方肌阻滞联合全麻组(Q 组)和单纯全麻组(G 组), 每组120例。Q 组于全麻诱导后手术前行超声引导下双侧腰方肌阻滞, 每侧给予0.375%罗哌卡因20 ml, G 组行单纯全麻。所有患者术前1 d采用简易精神状态检查表(MMSE)评估患者基础认知状态。术中记录手术时间、术中失血量、术中输液量、瑞芬太尼和丙泊酚消耗量、术中输血和使用阿托品的患者例数。术后记录PCIA有效按压次数, 使用意识紊乱测试法评估患者是否发生谵妄。记录术后恶心呕吐(PONV)、苏醒期躁动, 苏醒延迟及呼吸抑制等不良事件的发生情况。
结果 两组患者术前1 d MMSE评分、手术时间、术中失血量、术中输液量、术中输血和使用阿托品的患者例数差异无统计学意义。与G组比较, Q组术中瑞芬太尼和丙泊酚消耗量明显减少(P<0.05), 术后0～6 h、6～12 h和12～24 h时段PCIA有效按压次数明显减少(P<0.05), 术后2、3 d发生谵妄明显减少(P<0.05), PONV发生例数明显减少(P<0.05)。Q组无一例患者出现苏醒期躁动、苏醒延迟和呼吸抑制。
结论 腰方肌阻滞联合全麻可明显减少老年患者腹腔镜直肠癌根治术后全麻药物用量, 术后镇痛效果满意, 并减少老年患者术后谵妄的发生。 |
| 英文摘要: |
Objective To investigate the effect of quadratus lumborum block combined with general anesthesia on postoperative delirium in elderly patients undergoing laparoscopic radical resection of rectal cancer.
Methods A total of 240 elderly patients who were undergoing laparoscopic radical resection of rectal cancer, of which 148 males and 92 females, aged 65-80 years, weight 45-85 kg, ASA physical status Ⅰ or Ⅱ. They were randomly divided into, quadratus lumborum block combined with general anesthesia group(group Q) and simple general anesthesia group (group G), 120 cases in each. After induction, the patients in group Q underwent ultrasound-guided bilateral quadratus lumborum block before surgery. 40 ml of 0.375% ropivacaine was given to these patients.Patients in group G received general anesthesia alone. Baseline cognitive function was assessed using Mini-Mental State Examination scores in the day before operation.Time of operation, hemorrhage volume, fluid volume, the consumption of propofol and remifentanil, the number of blood transfusion and using atropine were recorded during operation. The effective pressing numbers of PCIA were recorded after operation. Postoperative delirium was measured using the Confusion Assessment Method. PONV, emergence agitation, delayed recovery and respiratory depression were recorded.
Results MMSE scores, time of operation, hemorrhage volume, fluid volume, the number of blood transfusion and using atropine had no statistical difference between the two groups.Compared with group G, the consumption of propofol and remifentanilin group Q significantly decreased(P<0.05), the effective pressing numbers of PCIA in group Q significantly decreased during 0-6 h, 6-12 h and 12-24 h(P<0.05), the incidence of postoperative delirium significantly decreased in 2, 3 day after operation(P<0.05), the cases of PONV occurred significantly reduced (P<0.05), and there was no case of emergence agitation, delayed recovery and respiratory depression.
Conclusion Quadratus lumborum block combined with general anesthesia can reduce the dosage of anesthetics for elderly patients undergoing laparoscopic resection of rectal cancer, provide a satisfactory analgesia and reduce the incidence of postoperative delirium. |
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