摘要
目的:探讨超声引导下腹部神经阻滞对老年患者术后疼痛及认知状态的影响.方法:回顾性分析本院2017年4月~2020年4月收治的80例老年腹部手术患者,根据镇痛模式的选择分为全麻-神经阻滞组(44例)和全麻组(36例).比较两组的术中情况(麻醉时间、手术时间、术中出血量)、术后24 h内舒芬太尼自控镇痛用量与追加次数、术后24 h和术后48 h的静息状态与运动状态下疼痛程度(VAS疼痛评分)、入室时和术后24 h的血清细胞白介素6(IL-6)、超敏-C反应蛋白(Hs-CRP)水平、术后7 d内POCD发生率和不良反应发生率.结果:两组患者麻醉时间、手术时间、术中出血量的差异均无统计学意义;全麻-神经阻滞组患者的24 h内舒芬太尼用量、追加次数、术后24 h和48 h的静息疼痛评分和运动疼痛评分均低于全麻组;两组患者术后24 h的血清IL-6、Hs-CRP均较入室时升高,全麻-神经阻滞组术后24 h的血清IL-6、Hs-CRP低于全麻组;两组患者术后POCD发生率和不良反应总发生率无明显差异.结论:全麻-神经阻滞继以静脉自控镇痛用于老年腹部手术患者的镇痛效果优于全麻继以静脉自控镇痛,舒芬太尼用量减少,炎性因子变化小,但两种方法术后POCD发生率无明显差异.
Objective To investigate the effect of ultrasound-guided abdominal nerve block on postoperative pain and cognitive status in elderly patients.Methods 80 elderly patients with abdominal surgery treated in our hospital from April 2017 to April 2020 were analyzed retrospectively,according to the choice of analgesic mode,they were divided into general anesthesia abdominal nerve block group(44 cases)and general anesthesia group(36 cases).The intraoperative conditions(anesthesia time,operation time,intraoperative blood loss),the amount of sufentanil controlled analgesia and the number of supplements within 24 h after surgery,and the resting state at 24 h and 48 h after surgery were compared between the two groups The level of pain under exercise(VAS pain score),serum cytokine interleukin 6(IL-6)and high sensitivity C-reactive protein(hs-CRP)level,the incidence of POCD and the incidence of adverse reactions within 7 days after surgery.Results There was no significant difference in anesthesia time,operation time,and intraoperative blood loss between the two groups.In the general anesthesia abdominal nerve block group,the dosage of sufentanil within 24 hours,the number of supplements,the resting pain scores and sports pain scores at 24 and 48 h after surgery were significantly lower than those in the general anesthesia group.The levels of serum IL-6 and Hs-CRP in the two groups of patients at 24 h after operation were higher than those at the time of entry.IL-6 and Hs-CRP were significantly lower than those in the general anesthesia group.The incidence of POCD and the total incidence of adverse reactions were no significant difference between the two groups.Conclusion The analgesic effect of general anesthesia abdominal nerve block group followed by intravenous patient—controlled analgesia in elderly patients undergoing abdominal surgery is better than that of general anesthesia.After intravenous patient-controlled analgesia,the dosage of sufentanil is reduced and the change of inflammatory factors is small,but there is no significant difference in the incidence of POCD between the two methods.
作者
潘琦
产进中
金侃
雷彦刚
Pan Qi;Chan Jin-zhong;Jin Kan;Lei Yan-gang(Department of Anesthesiology,Anqing First People Hospital Affiliated to Anhui Medical University,Anqing 246000,China;Department of Anesthesiology Xi’an Encephalopathy Hospital of Traditional Chinese Medicine,Xi'an 710043,China)
出处
《晓庄学院学报（医学版）》
2022年第2期108-111,共4页
Journal of Hunan Normal University(Medical Sciences)
关键词
麻醉方案
老年
腹部手术
镇痛效果
认知功能障碍
炎性因子
anesthesia plan
elderly
abdominal surgery
analgesic effect
cognitive dysfunction
inflammatory factor
