超声引导下胸椎旁连续阻滞对食管癌根治术老年患者术后谵妄的影响
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摘要
目的观察超声引导下置管连续胸椎旁阻滞(paravertebral block, PVB)用于开胸手术镇痛对患者术后谵妄(postoperative delirium,POD)的影响。方法选择择期在全麻下接受食管癌根治术的老年患者112例,男55例,女57例,年龄65～75岁,BMI 18.5～30 kg/m~2,ASAⅠ或Ⅱ级,随机分为两组:胸椎旁阻滞PVB组(P组)和静脉自控镇痛PCIA组(C组),P组54例,C组58例。P组使用PVB,C组使用舒芬太尼PCIA。记录术后1、2和3 d患者发生POD的情况;术中丙泊酚和瑞芬太尼的用量;患者术后不同时点静息和咳嗽时VAS评分;术后肺不张、恶心呕吐及皮肤瘙痒的发生情况。结果 P组术后POD发生率明显低于C组(P<0.05或P<0.01);P组术中丙泊酚与瑞芬太尼用量明显少于C组(P<0.01);术后不同时点两组静息时VAS评分差异无统计学意义,咳嗽时P组VAS评分明显低于C组(P<0.05或P<0.01);P组术后肺不张、恶心呕吐和瘙痒发生率明显低于C组(P<0.05或P<0.01)。结论全身麻醉联合连续胸椎旁阻滞用于老年患者开胸手术镇痛可以提供更充分的术中与术后镇痛,减少麻醉药物使用,降低POD的发生率。
Objective To investigate the effects of ultrasound-guided continuous thoracic paravertebral block on postoperative delirium(POD) in patients undergoing oesophagectomy. Methods A total of 112 elderly patients scheduled for esophagectomy under general anesthesia, 55 males and 57 females, aged 65-75 years, with a BMI 18.5-30 kg/m~2,falling into ASA physical status Ⅰor Ⅱ, were divided randomly into two groups: thoracic paravertebral block group(group P, n=54) and patient controlled intravenous analgesia(PCIA) group with sufentanil(group C, n=58). Delirium was recorded on the 1~(st), 2~(nt) and 3~d day of post-operation. The intraoperative dosage of remifentanil and propofol were recorded. Visual analog scale(VAS) scores at rest and cough were recorded at different time-points, and pulmonary atelectasis, nausea, vomiting and itching of all patients were recorded after operation. Results The incidence of POD in group P were significantly lower than that in group C(P < 0.01 or P < 0.05). The total dosage of remifentanil and propofol was less that in group P than in group C(P < 0.01). There was no statistical significant difference between the two groups in VAS scores at rest, but VAS scores at cough in group P were less than that in group C during the postoperative 48 hours(P < 0.01 or P < 0.05). Postoperative complications of pulmonary atelectasis, nausea, vomiting and itching in group P were lower than in group C(P < 0.01 or P < 0.05). Conclusion General anesthesia unite ultrasound-guided continuous thoracic paravertebral block can provide more adequate intraoperative and postoperative analgesia, reduce the use of anesthetics, and reduce the incidence of POD in elderly patients undergoing thoracotomy.
Objective To investigate the effects of ultrasound-guided continuous thoracic paravertebral block on postoperative delirium(POD) in patients undergoing oesophagectomy. Methods A total of 112 elderly patients scheduled for esophagectomy under general anesthesia, 55 males and 57 females, aged 65-75 years, with a BMI 18.5-30 kg/m~2,falling into ASA physical status Ⅰor Ⅱ, were divided randomly into two groups: thoracic paravertebral block group(group P, n=54) and patient controlled intravenous analgesia(PCIA) group with sufentanil(group C, n=58). Delirium was recorded on the 1~(st), 2~(nt) and 3~d day of post-operation. The intraoperative dosage of remifentanil and propofol were recorded. Visual analog scale(VAS) scores at rest and cough were recorded at different time-points, and pulmonary atelectasis, nausea, vomiting and itching of all patients were recorded after operation. Results The incidence of POD in group P were significantly lower than that in group C(P < 0.01 or P < 0.05). The total dosage of remifentanil and propofol was less that in group P than in group C(P < 0.01). There was no statistical significant difference between the two groups in VAS scores at rest, but VAS scores at cough in group P were less than that in group C during the postoperative 48 hours(P < 0.01 or P < 0.05). Postoperative complications of pulmonary atelectasis, nausea, vomiting and itching in group P were lower than in group C(P < 0.01 or P < 0.05). Conclusion General anesthesia unite ultrasound-guided continuous thoracic paravertebral block can provide more adequate intraoperative and postoperative analgesia, reduce the use of anesthetics, and reduce the incidence of POD in elderly patients undergoing thoracotomy.
引文
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[3] Reddy SV,Irkal JN,Srinivasamurthy A.Postoperative delirium in elderly citizens and current practice.J Anaesthesiol Clin Pharmacol,2017,33(3):291-299.
[4] Cui V,Tedeschi CM,Kronzer VL,et al.Protocol for an observational study of delirium in the post-anaesthesia care unit (PACU) as a potential predictor of subsequent postoperative delirium.BMJ Open,2017,7(7):e016402.
[5] Zhang Y,Li HJ,Wang DX,et al.Impact of inhalational versus intravenous anaesthesia on early delirium and long-term survival in elderly patients after cancer surgery:study protocol of a multicentre,open-label,and randomised controlled trial.BMJ Open,2017,7(11):e018607.
[6] Leung JM,Sands LP,Lim E,et al.Does preoperative risk for delirium moderate the effects of postoperative pain and opiate use on postoperative delirium?Am J Geriatr Psychiatry,2013,21(10):946-956.
[7] Sun Z,Sessler DI,Dalton JE,et al.Postoperative hypoxemia is common and persistent:a prospective blinded observational study.Anesth Analg,2015,121(3):709-715.
[8] Yang Y,Zhao X,Dong T,et al.Risk factors for postoperative delirium following hip fracture repair in elderly patients:a systematic review and meta-analysis.Aging Clin Exp Res,2017,29(2):115-126.
[9] 吕晓春,周雁.膝关节置换患者术后谵妄的危险因素分析.临床麻醉学杂志,2017,33(3):264-268.
[10] Swart LM,van der Zanden V,Spies PE,et al.The comparative risk of delirium with different opioids:a systematic review.Drugs Aging,2017,34(6):437-443.