超声引导下腰方肌阻滞对结直肠癌手术患者术后早期认知功能的影响
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摘要
目的探讨超声引导腰方肌阻滞(QLB)对结直肠癌(CRC)手术患者术后疼痛、睡眠质量、血清细胞因子及术后早期认知功能的影响。方法选择择期全麻下行开腹CRC根治术患者76例,性别不限,年龄50～75岁,ASAⅡ或Ⅲ级,随机均分为两组:QLB组(Q组)和对照组(C组)。两组麻醉诱导采用静注咪达唑仑0.03mg/kg、舒芬太尼0.5μg/kg、依托咪酯0.3mg/kg和罗库溴铵1mg/kg。麻醉维持静注瑞芬太尼0.2～0.3μg·kg-1·min-1和丙泊酚0.10～0.15 mg·kg-1·min-1。Q组术毕且拔管前在超声引导下行双侧QLB,腰方肌和腰大肌之间注入0.375%罗哌卡因20ml,C组仅给予等容量生理盐水。术前和术后第7天行认知功能测试。VAS评分评估术后疼痛,BIS监测评估睡眠质量;于术毕即刻(T0)、术后1h (T1)、术后2d(T2)、术后4d (T3)、术后7d(T4)时采用ELISA法检测血清IL-6、IL-1β、TNF-α、CGRP含量。结果 76例患者完成认知功能测试(Q组38例,C组38例),Q组判定为POCD 4例(10.5%),C组12例(31.6%)。与C组比较,Q组POCD发生率、术后24h和48h的VAS评分明显降低(P<0.05);深睡眠时间更长,T2、T3时血清IL-6、IL-1β、TNF-α含量明显降低,T2-T4时血清CGRP含量明显升高(P<0.05或P<0.01)。结论超声引导下腰方肌阻滞明显改善了老年患者CRC术后早期认知功能,可能与减轻术后疼痛、术后早期全身炎症反应、改善睡眠质量有关。
Objective To investigate the effect of ultrasound-guided quadratus lumborum block on cognitive function after laparoscopic colorectal surgery.Methods Seventy-six patients,there is no restriction on gender,aged 50-75 years,falling into ASA physical statusⅡorⅢ,who provided informed consent for their participation in this study and underwent colorectal surgery under general anesthesia were divided into two groups(groups Q and C).Induction of anesthesia was induced by intravenous midazolam 0.03 mg/kg,sufentanil 0.5μg/kg,etomidate 0.3 mg/kg and rocuronium 1 mg/kg in the two groups.Remifentanil 0.2-0.3μg·kg-1·min-1 and propofol 0.10-0.15 mg·kg-1·min-1 were maintained intravenously during anesthesia.0.375%ropivacaine 20 ml was injected between the psoas quadratus muscle and psoas major muscle under ultrasound guidance before extubation in group Q,only equal volume saline was given in group C.Neuropsychological tests were performed preoperatively as well as postoperative day 7.The postoperative pain was evaluated by VAS after surgery.The postoperative sleep quality was measured using a BIS-vista monitor.The changes of serum IL-6,IL-1β,TNF-αand CGRP levels were detected by ELISA at immediately after operation(T0),1 hour(T1),2 days(T2),4 days(T3)and 7 days(T4)after operation.Results Seventy-six patients finished cognitive function tests(38 cases in group Q and 38 cases in group C),12 cases(31.6%)were diagnosed as POCD in group C,4 cases(10.5%)in group Q.Compared with group C,the incidence of POCD,VAS scores at 24 and 48 hours after operation in group Q were significantly lower(P<0.05),the sleeping time at night was longer,the serum levels of IL-6,IL-1βand TNF-αwere significantly lower at T2 and T3,and the serum levels of CGRP were significantly higher at T2-T4(P<0.05 or P<0.01).Conclusion QLB treatment repaired the surgery induced early cognitive dysfunction by inhibiting the postoperative pain,excessive inflammatory response and improving the quality of sleep.
Objective To investigate the effect of ultrasound-guided quadratus lumborum block on cognitive function after laparoscopic colorectal surgery.Methods Seventy-six patients,there is no restriction on gender,aged 50-75 years,falling into ASA physical statusⅡorⅢ,who provided informed consent for their participation in this study and underwent colorectal surgery under general anesthesia were divided into two groups(groups Q and C).Induction of anesthesia was induced by intravenous midazolam 0.03 mg/kg,sufentanil 0.5μg/kg,etomidate 0.3 mg/kg and rocuronium 1 mg/kg in the two groups.Remifentanil 0.2-0.3μg·kg-1·min-1 and propofol 0.10-0.15 mg·kg-1·min-1 were maintained intravenously during anesthesia.0.375%ropivacaine 20 ml was injected between the psoas quadratus muscle and psoas major muscle under ultrasound guidance before extubation in group Q,only equal volume saline was given in group C.Neuropsychological tests were performed preoperatively as well as postoperative day 7.The postoperative pain was evaluated by VAS after surgery.The postoperative sleep quality was measured using a BIS-vista monitor.The changes of serum IL-6,IL-1β,TNF-αand CGRP levels were detected by ELISA at immediately after operation(T0),1 hour(T1),2 days(T2),4 days(T3)and 7 days(T4)after operation.Results Seventy-six patients finished cognitive function tests(38 cases in group Q and 38 cases in group C),12 cases(31.6%)were diagnosed as POCD in group C,4 cases(10.5%)in group Q.Compared with group C,the incidence of POCD,VAS scores at 24 and 48 hours after operation in group Q were significantly lower(P<0.05),the sleeping time at night was longer,the serum levels of IL-6,IL-1βand TNF-αwere significantly lower at T2 and T3,and the serum levels of CGRP were significantly higher at T2-T4(P<0.05 or P<0.01).Conclusion QLB treatment repaired the surgery induced early cognitive dysfunction by inhibiting the postoperative pain,excessive inflammatory response and improving the quality of sleep.
引文
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[3]Moller JT,Cluitmans P,Rasmussen LS,et al.Long-term postoperative cognitive dysfunction in the elderly ISPOCD1study.ISPOCD investigators.International Study of PostOperative Cognitive Dysfunction.Lancet,1998:351(9106):857-861.
[4]Bourne RS,Mills GH,Minelli C.Melatonin therapy to improve nocturnal sleep in critically ill patients:encouraging results from a small randomised controlled trial.Crit Care,2008,12(2):R52.
[5]Carline L,McLeod GA,Lamb C.A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks.Br J Anaesth,2016,117(3):387-394.
[6]张媛,钱燕宁,斯妍娜,等.结直肠手术后认知功能障碍患者血清细胞因子的差异表达.细胞与分子免疫学杂志,2015:31(2):231-234.
[7]Chiu IM,Heesters BA,Ghasemlou N,et al.Bacteria activate sensory neurons that modulate pain and inflammation.Nature,2013,501(7465):52-57.
[8]Yang X,Shi Z,Li X,et al.Impacts of stellate ganglion block on plasma NF-κB and inflammatory factors of TBI patients.Int J Clin Exp Med,2015,8(9):15630-15638.
[9]Harada N,Zhao J,Kurihara H,et al.Resveratrol improves cognitive function in mice by increasing production of insulinlike growth factor-I in the hippocampus.J Nutr Biochem,2011,22(12):1150-1159.
[10]Jin F,Li XQ,Tan WF,et al.Effects of ultrasound-guided stellate-ganglion block on sleep and regional cerebral oxygen saturation in patients undergoing breast cancer surgery:a randomized,controlled,double-blinded trial.J Clin Monit Comput,2018,32(5):855-862.
[2]王建平.中国《结直肠癌诊疗规范(2010版)》解读.中华胃肠外科杂志,2011,14(1):1-4.
[3]Moller JT,Cluitmans P,Rasmussen LS,et al.Long-term postoperative cognitive dysfunction in the elderly ISPOCD1study.ISPOCD investigators.International Study of PostOperative Cognitive Dysfunction.Lancet,1998:351(9106):857-861.
[4]Bourne RS,Mills GH,Minelli C.Melatonin therapy to improve nocturnal sleep in critically ill patients:encouraging results from a small randomised controlled trial.Crit Care,2008,12(2):R52.
[5]Carline L,McLeod GA,Lamb C.A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks.Br J Anaesth,2016,117(3):387-394.
[6]张媛,钱燕宁,斯妍娜,等.结直肠手术后认知功能障碍患者血清细胞因子的差异表达.细胞与分子免疫学杂志,2015:31(2):231-234.
[7]Chiu IM,Heesters BA,Ghasemlou N,et al.Bacteria activate sensory neurons that modulate pain and inflammation.Nature,2013,501(7465):52-57.
[8]Yang X,Shi Z,Li X,et al.Impacts of stellate ganglion block on plasma NF-κB and inflammatory factors of TBI patients.Int J Clin Exp Med,2015,8(9):15630-15638.
[9]Harada N,Zhao J,Kurihara H,et al.Resveratrol improves cognitive function in mice by increasing production of insulinlike growth factor-I in the hippocampus.J Nutr Biochem,2011,22(12):1150-1159.
[10]Jin F,Li XQ,Tan WF,et al.Effects of ultrasound-guided stellate-ganglion block on sleep and regional cerebral oxygen saturation in patients undergoing breast cancer surgery:a randomized,controlled,double-blinded trial.J Clin Monit Comput,2018,32(5):855-862.