Objective: To evaluate the effects of different postoperative analgesic strategies on neurocognitive function and quality of recovery in elderly patients at 7 days after thoracic surgery with one lung ventilation.
Methods: Ninety elderly patients undergoing video-assisted thoracic surgery were randomized into 3 groups (n=30) to receive postoperative analgesia with thoracic paravertebral block analgesia (TA), epidural analgesia (EA) and intravenous analgesia (GA). Before and at 7 days after the surgery, the patients' cognitive function was assessed using Mini-Mental State Examination (MMSE), and their early recovery at 7 days postoperatively was evaluated using Quality of Recovery-40 items (QoR-40).
Results: The patients in TA and EA groups had significantly higher MMSE scores and lower incidence of postoperative neurocognitive dysfunction (PNCD) than those in GA group without significant difference between the former two groups. At 7 days after the surgery, serum levels of S100-β and MMP-9 were significantly higher in GA group than in TA and EA group, and did not differ significantly between the latter two groups. QoR-40 scores were significantly higher in TA and EA groups than in GA group, and were higher in TA group than in EA group. The chest intubation time and length of hospital stay were significantly shorter in TA and EA groups than in GA group.
Conclusions: In elderly patients undergoing surgeries with one lung ventilation, general anesthesia combined with either postoperative continuous thoracic paravertebral block or epidural analgesia can significantly improve postoperative neurocognitive function and quality of recovery, but continuous thoracic paravertebral block analgesia can be more advantageous for improving postoperative quality of recovery.
目的: 评价不同术后镇痛策略对老年单肺通气患者术后神经认知功能和早期康复的影响。
方法: 选择择期拟行胸腔镜手术的老年患者90例，采用随机数字表法将其分为椎旁阻滞镇痛组（TA），硬膜外镇痛组（EA）及静脉镇痛组（GA），每组30例。采用简易智能精神量表（MMSE）对患者术前1 d和术后7 d的认知功能进行评估并记录术后7 d的40项康复质量（QoR-40）评分。
结果: TA组和EA组术后7 d的MMSE评分显著高于GA组，而PNCD的发生率低于GA组（P＜0.05），前两组间没有统计学差异（P＞0.05）；GA组术后7 d的S100-β及MMP-9水平显著高于TA、EA两组（P＜0.05），而后两组之间没有统计学差异（P＞0.05）；TA和EA组术后7 d的QoR-40评分高于GA组（P＜0.05），但TA组评分优于EA组（P＜0.05）；与GA组相比，TA和EA两组术后胸管拔出时间及住院时间均缩短（P＜0.05），而两组间没有统计学差异（P＞0.05）。
结论: 全身麻醉复合术后持续胸椎旁阻滞或硬膜外镇痛能够明显改善老年单肺通气患者术后神经认知功能和早期康复，但胸椎旁阻滞镇痛在术后早期恢复质量方面更有优势。
Keywords: continuous thoracic paravertebral block; postoperative analgesia; postoperative neurocognitive dysfunction; quality of recovery.