Effects of different postoperative analgesic strategies on postoperative neurocognitive function and quality of recovery in elderly patients undergoing one lung ventilation / 南方医科大学学报

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 (@*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.

Influence of CTPVB under ultrasound-guidance combined with general anesthesia on inflammatory reaction and homodynamic of patients with thoracotomy / 中国医学装备

Objective: To explore influence of continuous thoracic paravertebral block(CTPVB)under ultrasound-guidance combined with general anesthesia on inflammatory reaction and homodynamic of patients who underwent thoracotomy.Methods: 138 patients who underwent thoracotomy were prospectively selected and were divided into observation group(69 cases)and control group(69 cases)as random number table.Patients of observation group received CTPVB under ultrasound-guidance combined with general anesthesia and that of control group received general anesthesia.The changes of IL-6,IL-10 and TNF-α postoperative 48h and postoperative VAS score between the two groups were compared.And the VAS scores postoperative 2h,12h,24h and 48h also were observed.Besides,the mean arterial pressure and heart rate between the two groups at various time point included tranquillization time(T0),the 15 min(T1)after CTPVB combined with general anesthesia,the time post induced intubation(T2),5 min post skin incision(T3)and the time pre extubation(T4)were compared and analyzed so as to research its influence on hemodynamic.Results: The IL-6 and TNF-α postoperative 48h of observation group were significantly lower than that of control group(t=15.95,t=46.99,P＜0.05).And postoperative IL-10 of observation group was significantly higher than that of control group(t=134.3,P＜0.05).And the VAS scores of observation group at postoperative 2h,12h,24h and 48h were significantly lower than that of control group(t=13.91,t=17.1,t=2.321,t=9.231,P＜0.05),respectively.Conclusion: CTPVB under ultrasound-guidance combined with general anesthesia can improve postoperatively analgesic effect for patients,and it don't affect patients' blood pressure and heart rate,and it can reduce inflammatory reaction of patients who underwent thoracotomy and promote rehabilitation of patients.