全身麻醉联合硬膜外阻滞对腹腔镜结肠癌根治术患者POCD的影响

发布时间：2018-10-05 20:02

【摘要】：目的:观察全身麻醉联合硬膜外阻滞对腹腔镜结肠癌根治术患者术后认知功能障碍(POCD)的影响,并分析影响患者POCD发生的因素。方法:以接受腹腔镜结肠癌根治术的80例患者为研究对象,并随机分为对照组和观察组,每组各40例,其中对照组给予全身麻醉,观察组给予全身麻醉+硬膜外阻滞。观察两组患者术后POCD的发生率,比较两组患者简易智力状况检查法(MMSE)评分、镇静镇痛评分及POCD发生率,比较两组患者S-100β、IL-6和TNF-α水平。分析影响POCD发生的因素。结果:两组患者手术前的MMSE得分无明显差别(P0.05),观察组患者手术后1 h和术后1 d的MMSE得分高于对照组(P0.05),发生POCD的例数少于对照组(P0.05),两组患者在术后7 d时的MMSE评分和发生POCD的例数无明显差别(P0.05);两组患者手术前的VAS和Ramsay评分无明显差别(P0.05),术后1 h、术后1 d和术2 d,观察组患者的VAS评分低于对照组(P0.05),Ramsay评分高于对照组(P0.05);手术前两组患者的S-100β、IL-6和TNF-α水平无明显差别(P0.05),术后1 d时,两组患者的上述指标水平均增高(P0.05),但观察组低于对照组(P0.05)。VAS评分、Ramsay评分、麻醉方式、S-100β、IL-6和TNF-α是影响患者发生POCD的危险因素(P0.05)。结论:全身麻醉联合硬膜外阻滞腹腔镜结肠癌根治术可降低患者术后早期发生POCD的概率,可能与该种麻醉方式镇静镇痛效果较好,并可调节相关细胞因子水平有关。
[Abstract]:Aim: to observe the effect of general anesthesia combined with epidural block on (POCD) of patients with cognitive dysfunction after laparoscopic radical resection of colon cancer, and to analyze the factors affecting the occurrence of POCD. Methods: 80 patients undergoing laparoscopic radical resection of colon cancer were randomly divided into control group (n = 40) and observation group (n = 40). The control group received general anesthesia and the observation group received general anesthesia epidural block. The incidence of POCD, (MMSE) score, sedative analgesia score and POCD incidence were compared between the two groups, and the levels of S-100 尾 -IL-6 and TNF- 伪 were compared between the two groups. The factors influencing the occurrence of POCD were analyzed. Results: there was no significant difference in MMSE score between the two groups before operation (P0.05). The MMSE score of the observation group was higher than that of the control group at 1 hour after operation and 1 day after operation (P0.05), and the number of POCD cases in the two groups was less than that in the control group (P0.05). The MMSE score of the two groups at 7 days after operation was higher than that in the control group (P0.05). The scores of VAS and Ramsay were not significantly different between the two groups before operation (P0.05), the VAS scores of patients in the observation group were lower than those in the control group (P0.05), and the scores of VAS in the observation group were lower than those in the control group (P0.05), and the scores of VAS in the observation group were higher than those in the control group (P0.05). There was no significant difference in the levels of S-100 尾 -IL-6 and TNF- 伪 between the first two groups (P0.05). The above indexes in both groups were increased (P0.05), but the observation group was lower than the control group (P0.05) .VAS score and Ramsay score. The anesthetic style of S-100 尾 -IL-6 and TNF- 伪 were the risk factors influencing the occurrence of POCD (P0.05). Conclusion: general anesthesia combined with epidural block laparoscopic radical resection of colon cancer can reduce the probability of early occurrence of POCD in patients with colon cancer, which may be related to the effect of sedation and analgesia and the regulation of cytokines.
【作者单位】：湖北省武汉市汉南区人民医院麻醉科;湖北省武汉市汉南区人民医院普外科;
【分类号】：R614;R735.35

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