The Effect Of Ultrasound-guided Paravertebral Block On Short-term Cognition In Elderly Patients With Diabetes Mellitus After Thoracoscope Resection Of Lung Cancer

Objective Perioperative neurocognitive disorders is used as an overarching term for cognitive impairment or change identified in the preoperative or postoperative period.It includes cognitive impairment diagnosed before operation and cognitive decline up to 30 days after the procedure and even up to 12 months.Postoperative delirium is a reversible state of impaired cognition,inattention,and altered level of consciousness after surgery.It usually occurs within one week after surgery and is more common in major surgery such as cardiothoracic surgery.Postoperative cognitive dysfunction refers to functional decline in the neuropsychological field after surgery or anesthesia,including memory,executive ability,and reduced processing speed.More and more studies suggest that diabetes is an independent risk factor for postoperative cognitive dysfunction.In recent years,ultrasound-guided thoracic paravertebral nerve block is widely used in cardiothoracic surgery anesthesia,which has the advantages of high success rate of puncture,reducing perioperative stress response,decreasing the amount of anesthetic drugs,and providing effective analgesia.Study indicated that thoracic paravertebral nerve block can improve postoperative cognitive function in the elderly with thoracotomy.Because diabetic patients are in a state of high sugar for a long time,persistent high glucose may damage nerves and affect normal nerve function.Therefore,whether it affects postoperative cognition of diabetic patients is not clear,and it is rarely reported in China.This study was to observe the effect of ultrasound-guided thoracic paravertebral nerve block on short-term cognitive level after thoracoscope resection of lung cancer in diabetic patients,and to choose a more reasonable anesthesia protocol for diabetic patients.Methods60 patients of both sexes,aged>18 yr,BMI 18.5-27 kg/m²,of American Society of Anesthesiologists physical status II or III,preoperative Mini-Mental State Examination score?24,scheduled for elective thoracoscope resection of lung cancer,were divided into general anesthesia group?group G,n=30?and ultrasound-guided paravertebral block combined with general anesthesia?group U,n=30?.Both group G and group U received the same general anesthesia and patient-controlled intravenous analgesia.Patients in group U received ultrasound-guided paravertebral block before anesthesia induction.At 10min before induction?T1?,1h after the beginning of surgery?T2?,at the end of surgery?T3?,6h after the end of surgery?T4?,and 24h after the end of surgery?T5?,venous blood samples were collected for determination of the level of blood glucose and serum interleukin-1,interleukin-6 and tumor necrosis factor-?were detected at T_1,3,5.Mean arterial pressure?MAP?and heart rate?HR?were recorded at T_1-5.Mini-Mental State Examination scores were assessed at 1day before surgery,1 and 7 days after surgery,and the occurrence of postoperative delirium was recorded in a short time period after surgery.Statistical results were analyzed using SPSS 16.0 software,and the difference was statistically significant at P<0.05.Results Compared with the baseline at T₁,the level of blood glucose at T_2-5,serum IL-1?IL-6?TNF-?concentrations at T_3,5were significantly increased?P<0.05?and MAP?HR at T_2,3,4were also significantly increased?P<0.05?in group G;serum IL-1?IL-6?TNF-?concentrations were significantly increased?P<0.05?at T_3,5,no significant change was found in the level of blood glucose at T_2,3,5?P>0.05?and there was also no significant change in MAP and HR at T_2,3,5?P>0.05?in group U.Compared with group G,the level of blood glucose at T_2-5-5 and serum IL-1?IL-6?TNF-?concentrations at T_3,5were significantly decreased?P<0.05?,MAP and HR were decreased?P<0.05?at T_2-4.For the rest,the intraoperative consumption of propofol,remifentanil and sulfentanyl were significantly decreased?P<0.01?in group U.No single case of intraoperative awareness happened in postoperative 24 hours investigation.Mini-Mental State Examination scores were increased at 1 and 7 day after operation in group U,and the incidence of postoperative delirium after operation was no difference between group G and U.Conclusion Ultrasound-guided paravertebral block can reduce the incidence of postoperative delirium in patients undergoing thoracoscope resection of lung cancer with diabetes.