腹横肌阻滞对老年结肠癌患者应激 及术后认知功能的影响

Effect of transversus abdominis plane block on physical stress and postoperative cognitive function in elderly colon cancer patients

摘要:

目的 对行结肠癌手术的老年患者实施腹横肌阻滞（TAP），探讨其对应激反应及术后认知功能 的影响。方法 选择拟在全身麻醉（以下简称全麻）下行结肠癌手术的老年患者50 例，随机分为腹横肌阻 滞联合全麻组和单纯全麻组。腹横肌阻滞联合全麻组于入室后10 min 常规进行双侧肋缘下TAP。测定入室 10 min、麻醉诱导后5 min、切皮5 min、切皮2 h 及手术结束即刻的血糖（GLU）、C- 反应蛋白（CRP）浓度。 测定术前1 d、入室10 min、手术结束即刻、术后1 和2 d 血清中神经元特异性烯醇化酶（NSE）含量。采 用蒙特利尔认知评定量表（MoCA）、简易精神状态量表（MMSE）进行认知评估，记录两组患者围手期发生 认知功能损伤的情况。结果 两组患者平均动脉压、心率静态视觉模拟评分、GLU、NSE、MoCA 及MMSE 评分比较，差异有统计学意义（P <0.05）；两组患者不良反应发生率比较，差异有统计学意义（P <0.05）；两 组患者术后静脉自控镇痛泵按压次数比较，差异有统计学意义（P <0.05）；两组患者术后1 d 术后认知功能障 碍发生率比较，差异有统计学意义（P <0.05）。结论 TAP 应用于老年结肠癌手术患者，可降低机体围手术期 不良应激反应及认知功能损伤的发生率。

Abstract:

Objective To investigate the effect of transversus abdominis plane block (TAP) on physical stress and postoperative cognitive function in elderly patients undergoing colon cancer surgery. Methods Fifty elderly patients who were to undergo colon cancer surgery under general anesthesia were randomly divided into two groups: abdominal transverse muscle block combined general anesthesia group (group A, n = 25) and general anesthesia group (group G, n = 25). The patients in the group A received bilateral inferior lateral TAP 10 min after entering the operation room. Vital signs, and blood glucose (Glu) and c-reactive protein (CRP) concentrations were recorded 10 min after entering the room, 5 min after anesthesia induction, 5 min after skin cutting, 2 h after skin cutting, and immediately after surgery. The serum content of neuron-specific enolase (NSE) was measured 1 d before surgery, 10 min after entering the room, immediately after surgery, 1 and 2 d after surgery. The Montreal Cognitive Assessment Scale (MoCA) and Mini-Mental State Scale (MMSE) were used to assess the cognitive function, and the occurrence of cognitive impairment in the two groups was recorded during the perioperative period. Results There were significant differences in MAP, Glu, NSE, MoCA and MMSE scores between the two groups (P < 0.05). The incidence of adverse reactions, the number of times of compression of postoperative patient-controlled intravenous analgesia pump, and the incidence of postoperative cognitive impairment on the 1st d after operation were also significantly different between the two groups (P < 0.05). Conclusions The application of TAP in elderly colon cancer surgery can effectively reduce the incidences of adverse physical stress and cognitive impairment during perioperative period.