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双侧椎旁神经阻滞对行胃癌根治术的老年患者认知功能的影响:一项前瞻性随机双盲对照试验

2022-10-08 15:55

双侧椎旁神经阻滞对行胃癌根治术的老年患者认知功能的影响:一项前瞻性随机双盲对照试验

本文由“罂粟花"授权转载

双侧椎旁神经阻滞对行胃癌根治术的老年患者认知功能的影响:一项前瞻性随机双盲对照试验

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贵州医科大学    麻醉与心脏电生理课题组

翻译:宋雨婷  编辑:马艳燕  审校:曹莹

PART   0   1     秋风微凉  

目的:研究双侧椎旁神经阻滞(PVB)对拟行胃癌根治性胃切除术的老年患者认知功能的影响。

方法:将60名年龄在65-80岁拟行全麻下根治性胃切除术的患者(40名男性和20名女性)随机分为PVB组和对照组。PVB组患者术前在超声引导下用20 mL 0.375%罗哌卡因行单次T8水平双侧PVB,对照组患者不实行阻滞。两组患者均在BIS监测下行丙泊酚和瑞芬太尼全凭静脉麻醉。主要指标:通过简易精神状态检查(MMSE)和神经元特异性烯醇化酶(NSE)评估术后认知功能。

结果:PVB组的意识恢复时间短于C组(P<0.001),丙泊酚和瑞芬太尼用量小于C组(P=0.007)。此外,MMSE评分和NSE浓度从术前1天到术后1天和术后1天到术后3天变化显著(P<0.001)。

5081665025306801  

PART   02     秋风微凉  

结论:在胃癌根治性胃切除术中,单次双侧PVB可减少全麻药的使用,改善术后恢复,并为神经保护作用提供了替代性证据。

原始文献来源:Shang, Y., Qi, F., Zheng, Z. et al. Effect of bilateral paravertebral nerve block on cognitive function in elderly patients undergoing radical gastrectomy for gastric cancer: a prospective randomized double-blind controlled trial. BMC Anesthesiol 22, 224 (2022).

PART   0   3     英文原文  

Effect of bilateral paravertebral nerve block on cognitive function in elderly patients undergoing radical gastrectomy for gastric cancer: a prospective randomized double-blind controlled trial

Objective To investigate the effect of a bilateral paravertebral block (PVB) on cognitive function in elderly patients undergoing radical gastrectomy for gastric cancer.

Methods Sixty patients (40 men and 20 women) aged 65–80 undergoing radical gastrectomy surgery under general anaesthesia were included and randomly assigned to either the PVB group or the control group. Patients in the PVB group had before incision a single-shot ultrasound-guided bilateral PVB at the T8 level with 20 mL of ropivacaine 0.375%, while patients in the control group had no block. Patients in both groups had a BIS-guided total intravenous anaesthesia with propofol and remifentanil infusions. Postoperative cognitive function assessed by the mini-mental state examination (MMSE) and NSE (neuron-specific enolase) was the primary outcome.

Results The awareness time in group PVB was shorter than that in the group C, and the propofol and remifentanil dosages were less than that in group C (P<0.001, P = 0.007, respectively). Furthermore, the change of the MMSE score and the NSE concentration was significant from day0 to day1 and day1 to day2. (P<0.001).

Conclusion A single-shot bilateral PVB active throughout radical gastrectomy for gastric cancer reduces the needs for general anaesthetic agents and improve postoperative recovery, along with a surrogate evidence for neuroprotective effects

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