摘要
目的探讨星状神经节阻滞(SGB)对全身麻醉下维、汉族老年高血压胆囊切除术患者应激反应及术后认知功能障碍(POCD)的影响。方法选择维、汉族老年高血压胆囊切除术患者各30例,维、汉族患者均随机分为SGB组和非SGB组,术前1天及术后1、3和7 d采用简易智能状态检查量表(MMSE)评估患者认知功能,SGB组麻醉前行右侧SGB后予以麻醉诱导。非SGB组除入、离手术室不行SGB外,余处理同SGB组。比较维、汉族SGB组和非SGB组POCD发生率,同时检测诱导前、手术开始1 h、术毕及术后24 h患者血清皮质醇(Cor)、C反应蛋白(CRP)及白细胞介素6(IL-6)。结果 4组患者麻醉时间、吸入七氟醚、术中出血量、术后镇痛药用量比较,差异无统计学意义(P>0.05),维族组静脉麻醉药瑞芬太尼、丙泊酚用量与汉族组比较,差异有统计学意义(P<0.05),维族组较汉族组用量大;非SGB组瑞芬太尼、丙泊酚用量与SGB组比较,差异有统计学意义(P<0.05),非SGB组较SGB组用量大。同一观察时间,非SGB组患者中维族患者POCD发生率低于汉族患者,SGB组POCD发生率低于非SGB组,差异有统计学意义(P<0.05),维、汉族间Cor、CRP和IL-6比较,差异无统计学意义(P>0.05),SGB组Cor术中1 h、术毕、术后24 h低于非SGB组,SGB组CRP术中1 h、术毕低于非SGB组,差异均有统计学意义(P<0.05)。结论 POCD的发生率随着术后时间的延长有下降趋势,且维族患者POCD发生率低于汉族患者,SGB可减少麻醉药物的使用,抑制患者应激反应,减少POCD的发生,是否与Cor、CRP有关值得进一步研究。
Objective To explore whether stellate ganglion block（SGB） can influence stress response and postoperative cognitive dysfunction（POCD） in elderly Uighurs and Hans with hypertension undergoing cholecystectomy under general anesthesia. Methods In this study 30 Uighur and 30 Han patients aged 60-70 y undergoing cholecystectomy were respectively analyzed and randomly assigned to SGB group and NSGB group（15 in each group）. The cognitive function of these patients was evaluated by Mini-mental State Examination（MMSE）1 d before operation and 1, 3 and 7 d after operation. The four groups received the same induction medicine with Midazolam, Propofol, Sufentanil and Atracurium, whereas the SGB groups were administered right-side SGB before anesthesia and after operation. After intubation, the patients inhaled 1% Sevoflurane and 2 L/min O2, and were given target-controlled infusion of Propofol 2-3 μg/ml and Remifentanil 1-2 ng/ml to maintain bispectral index（BIS） value at 45-55. Serum cortisol（Cor）, C-reactive protein（CRP） and IL-6 were measured before induction, 1 h after the start of the operation, at the end of the operation and 24 h after operation. Results The occurrence rate of POCD reduced with the increasing time after operation. POCD occuring rate in the NSGB Uighurs group was lower than that in the NSGB Hans group（P〈0.05）. POCD occuring rate in the SGB groups was lower than that in the NSGB groups（P〈0.05）. Cor concentration in the NSGB groups was higher than that in the SGB groups 1 h after the start of the operation, at the end of the operation and 24 h after operation（P〈0.05）. CRP concentration in the SGB groups was lower than that in the NSGB groups 1 h after the start of the operation and at the end of the operation（P〈0.05）. Cor, CRP or IL-6 concentration had no significant difference between Uighurs and Hans（P〉0.05）. The dosages of anesthetic drugs such as Remifentanil and Propofol in the Uighurs group were higher than those in the Hans group（P〈0.05）. The dosages of Remifentanil and Propofol in the NSGB group were higher than those in the SGB group（P〈0.05）. Conclusions POCD often occurs in old patients and has a lower occurrence rate in Uighurs than in Hans. SGB is conducive to decrease the occuring rate of POCD and restrain stress response. Whether Cor and CRP are somewhat relevant to POCD needs further study.
作者
阮绪广
江伟航
黄铃燕
何颖宜
李婷
Xu-guang Ruan;Wei-hang Jiang;Ling-yan Huang;Ying-yi He;Ting Li(Department of Anesthesiology, Panyu Central Hospital, Guangzhou, Guangdong 511400, China;Department of Anesthesiology, Shufu County People’s Hospital, Shufu, Xingjiang 844100, China)
出处
《中国现代医学杂志》
CAS
2018年第16期59-63,共5页
China Journal of Modern Medicine
基金
广东省科技计划项目(No:2014A02020 9005)
