王竹 黄伯万 杨柳 潘秋宁

【摘要】 目的：探討超声引导下胸椎旁神经阻滞复合全身麻醉在老年肺癌根治术患者中应用对认知功能、肿瘤标志物、炎性反应和术后恢复情况的影响。方法：回顾性分析2018年3月-2019年9月于本院因非小细胞肺癌需手术治疗的68例老年患者的临床资料，按照不同麻醉方法将其分为观察组和对照组，各34例。观察组予以超声引导下胸椎旁神经阻滞复合全身麻醉，对照组予以全身麻醉。比较两组手术前后认知功能、肿瘤标志物、炎性因子和术后恢复指标以及术后2、12、24、48 h的疼痛视觉模拟评分（VAS）。结果：术后24 h，观察组MMSE评分高于对照组，IL-6、IL-10、TNF-α、CYFRA21-1、CA125、CA199和CEA水平均低于对照组，差异均有统计学意义（P<0.05）。观察组术后2、12、24、48 h的VAS评分均低于对照组，差异均有统计学意义（P<0.05）。观察组苏醒室停留时间、拔管时间、下床活动时间和住院时间均较对照组短，恶心呕吐例数较对照组少，差异均有统计学意义（P<0.05）。手术开始后2 h，观察组的收缩压、舒张压和心率均低于对照组，差异均有统计学意义（P<0.05）。结论：超声引导下胸椎旁神经阻滞复合全身麻醉在老年肺癌患者中应用可有效减轻疼痛，改善认知功能，降低肿瘤标志物水平，减轻炎症反应，促进康复，缩短住院时间，值得临床推广应用。

【关键词】 超声引导下胸椎旁神经阻滞 全身麻醉 肺癌 老年患者 认知功能 肿瘤标志物

[Abstract] Objective： To investigate the application of ultrasound-guided paravertebral nerve block combined general anesthesia on cognitive function， tumor markers， inflammatory response and postoperative recovery in elderly patients with lung cancer radical surgery. Method： The clinical data of 68 elderly patients with non-small cell lung cancer requiring surgical treatment in our hospital from March 2018 to September 2019 were retrospectively analyzed， according to different anesthesia methods， they were divided into observation group and control group， 34 cases in each group. The observation group was given ultrasound-guided parathoracic nerve block combined with general anesthesia， while the control group was given general anesthesia. The cognitive function， tumor markers， inflammatory factors and postoperative recovery indicators before and after surgery， as well as the pain visual analogue scale （VAS） at 2， 12， 24， 48 h after surgery were compared between the two groups. Result： 24 h after the operation， MMSE level of the observation group was higher than that of the control group， the levels of IL-6， IL-10， TNF-α， CYFRA21-1， CA125， CA199 and CEA were lower than those of the control group， with statistically significant differences （P<0.05）. VAS scores of the observation group at 2， 12， 24， 48 h after operation were all lower than those of the control group， with statistically significant differences （P<0.05）. In the observation group， the stay time in the waking room， extubation time， activity time out of bed and hospitalization time were shorter than those in the control group， the number of cases of nausea and vomiting was less than that in the control group， with statistically significant differences （P<0.05）. 2 h after the operation， the systolic blood pressure， diastolic blood pressure and heart rate in the observation group were all lower than those in the control group， with statistically significant differences （P<0.05）. Conclusion： Ultrasound-guided parathoracic nerve block combined with general anesthesia can effectively reduce pain， improve cognitive function， reduce tumor marker levels， reduce inflammatory response， promote rehabilitation， shorten hospital stay， it is worthy of clinical application.

[Key words] Ultrasound-guided parathoracic nerve block General anesthesia Lung cancer Elderly patients Cognitive function Tumor markers

肺癌是心胸外科最常见的恶性肿瘤疾病，病死率极高，根治术仍然是临床最常用的治疗手段[1-2]，发病为老年人多见，一般此人群体质差，常有慢性病史，如心脑血管疾病及糖尿病史，手术麻醉耐受性差;且胸科手术创伤大，疼痛剧烈，极易引起全身炎性反应，严重者会导致多器官器功能障碍综合征。选择合理精准、镇痛效果好的麻醉方式对围手术期的预后极为重要，临床经验显示，单纯予以全麻需较大剂量的镇静镇痛全身麻醉药，常会对老年患者心血管功能，内分泌，免疫系统和术后认知功能造成影响，近年来研究发现，超声引导下胸椎旁神经阻滞复合全身麻醉可有效减少全身麻醉药物用量，可行术后局部神经镇痛，减少术后并发症，促进预后，缩短住院时间[3]。……