Objective:To investigate the predictive value of regional cerebral oxygen saturation (rScO 2) for perioperative neurocognitive disorders (PND) in the preanalgesia of erector spinal plane block (ESPB) combined with parecoxib sodium in elderly patients undergoing radical lung cancer surgery. Methods:A total of 180 elderly patients with lung cancer treated inthe Sixth Affiliated Hospital of South China University of Technology (People's Hospital of Nanhai District) from June 2022 to June 2023 were selected. All patients underwent thoracoscopic radical resection of lung cancer, pre-analgesia by ESPB combined with parecoxib sodium, and rScO 2 was monitored by near infrared spectroscopy. Cognitive function was assessed at 1 d before surgery and 7 d after surgery, and the incidence of PND was determined according to the Z score method. Patients with PND were included in the observation group (21 cases) and those without PND were included in the control group (159 cases). The clinical data, preoperative and postoperative cognitive scale scores, and perioperative rScO 2 were compared between the two groups. Logistic regression model was used to analyze the risk factors of PND. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of rScO 2 to patients' PND. Results:Patients aged ≥75 years, postoperative incision infection, postoperative 1d visual analogue scale (VAS) ≥4 scores, intraoperative blood loss and operative time in the observation group were higher than those in the control group: 61.90%(13/21) vs.34.59%(55/159), 19.05%(4/21) vs. 3.77%(6/159), 42.86%(9/21) vs. 18.87%(30/159), (208.39 ± 61.05) ml vs. (172.45 ± 60.22) ml, (188.96 ± 62.13) min vs. (150.36 ± 52.17)min; the years of education in the observation group was shorter than that in the control group: (8.10 ± 2.25) years vs. (9.89 ± 2.04) years, there were statistical differences ( P<0.05). The scores of mini-mental state examination (MMSE), visual verbal learning test (VVLT), digital span test (DST1) and digital symbol test (DST2) at 7 d after surgery in both groups were lower than those befor surgery, and the scores of MMSE, VVLT, DST1 and DST2 at 7 d after surgery in the observation group were lower than those in the control group: (22.86 ± 2.05) scores vs. (24.85 ± 1.87) scores, (2.95 ± 1.95) scores vs. (4.83 ± 2.01) scores, (7.52 ± 1.83) scores vs. (9.04 ± 1.93) scores, (40.48 ± 5.05) scores vs. (44.35 ± 4.96) scores, there were statistical differences ( P<0.05). The decrease rate of rScO 2 from the baseline value at single lung ventilation 1 h (T 2) in the observation group was higher than that in the control group: (21.32 ± 5.13)% vs. (14.51 ± 5.02)%, there was statistical difference ( P<0.05). The results of Logistic regression analysis showed that rScO 2 reduction rate from the baseline value, age ≥75 years, postoperative 1 d after surgery VAS ≥4 scores, and operation time were independent risk factors for PND; the higher levels of rScO 2 at T 2 and after operation (T 3) were independent protective factors ( P<0.05). The results of ROC curve analysis showed that the area under the curve(AUC) of rScO 2 at T 2 and T 3 and the decrease rate of rScO 2 from the baseline value predicted that the PND in elderly patients with pre-analgesic radical lung cancer with ESPB combined with paracxib sodium were 0.742, 0.716 and 0.822, respectively, in which the AUC of the decrease rate of rScO 2 from the baseline value was the largest. Conclusions:rScO 2 can be used for predicting PND in the elderly patients with radical lung cancer after ESPB combined with parecoxib sodium, especiallythe predictive value of the decrease rate of rScO 2 from the baselinevalue is higher.

Objective:To investigate the predictive value of regional cerebral oxygen saturation (rScO 2) for perioperative neurocognitive disorders (PND) in the preanalgesia of erector spinal plane block (ESPB) combined with parecoxib sodium in elderly patients undergoing radical lung cancer surgery. Methods:A total of 180 elderly patients with lung cancer treated inthe Sixth Affiliated Hospital of South China University of Technology (People's Hospital of Nanhai District) from June 2022 to June 2023 were selected. All patients underwent thoracoscopic radical resection of lung cancer, pre-analgesia by ESPB combined with parecoxib sodium, and rScO 2 was monitored by near infrared spectroscopy. Cognitive function was assessed at 1 d before surgery and 7 d after surgery, and the incidence of PND was determined according to the Z score method. Patients with PND were included in the observation group (21 cases) and those without PND were included in the control group (159 cases). The clinical data, preoperative and postoperative cognitive scale scores, and perioperative rScO 2 were compared between the two groups. Logistic regression model was used to analyze the risk factors of PND. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of rScO 2 to patients' PND. Results:Patients aged ≥75 years, postoperative incision infection, postoperative 1d visual analogue scale (VAS) ≥4 scores, intraoperative blood loss and operative time in the observation group were higher than those in the control group: 61.90%(13/21) vs.34.59%(55/159), 19.05%(4/21) vs. 3.77%(6/159), 42.86%(9/21) vs. 18.87%(30/159), (208.39 ± 61.05) ml vs. (172.45 ± 60.22) ml, (188.96 ± 62.13) min vs. (150.36 ± 52.17)min; the years of education in the observation group was shorter than that in the control group: (8.10 ± 2.25) years vs. (9.89 ± 2.04) years, there were statistical differences ( P<0.05). The scores of mini-mental state examination (MMSE), visual verbal learning test (VVLT), digital span test (DST1) and digital symbol test (DST2) at 7 d after surgery in both groups were lower than those befor surgery, and the scores of MMSE, VVLT, DST1 and DST2 at 7 d after surgery in the observation group were lower than those in the control group: (22.86 ± 2.05) scores vs. (24.85 ± 1.87) scores, (2.95 ± 1.95) scores vs. (4.83 ± 2.01) scores, (7.52 ± 1.83) scores vs. (9.04 ± 1.93) scores, (40.48 ± 5.05) scores vs. (44.35 ± 4.96) scores, there were statistical differences ( P<0.05). The decrease rate of rScO 2 from the baseline value at single lung ventilation 1 h (T 2) in the observation group was higher than that in the control group: (21.32 ± 5.13)% vs. (14.51 ± 5.02)%, there was statistical difference ( P<0.05). The results of Logistic regression analysis showed that rScO 2 reduction rate from the baseline value, age ≥75 years, postoperative 1 d after surgery VAS ≥4 scores, and operation time were independent risk factors for PND; the higher levels of rScO 2 at T 2 and after operation (T 3) were independent protective factors ( P<0.05). The results of ROC curve analysis showed that the area under the curve(AUC) of rScO 2 at T 2 and T 3 and the decrease rate of rScO 2 from the baseline value predicted that the PND in elderly patients with pre-analgesic radical lung cancer with ESPB combined with paracxib sodium were 0.742, 0.716 and 0.822, respectively, in which the AUC of the decrease rate of rScO 2 from the baseline value was the largest. Conclusions:rScO 2 can be used for predicting PND in the elderly patients with radical lung cancer after ESPB combined with parecoxib sodium, especiallythe predictive value of the decrease rate of rScO 2 from the baselinevalue is higher.

Objective:To explore the application effect of anesthesia management based on cerebral oxygen saturation monitoring in elderly non-small cell lung cancer (NSCLC) radical surgery and its impact on patient cognitive function.Methods:Ninety elderly NSCLC patients who were treated at the Sixth Affiliated Hospital of South China University of Technology from June 2022 to January 2023 were selected. The patients were divided into an observation group ( n=45) and a control group ( n=45) using the envelope method. Both groups underwent radical lung cancer surgery under general anesthesia, while the control group received routine anesthesia management and the observation group received anesthesia management based on cerebral oxygen saturation monitoring. The surgical time, intraoperative blood loss, anesthesia time, remifentanil dosage, and propofol dosage were observed in two groups. At the same time, differences in serum interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), and other levels were compared between the two groups. Results:There was no statistically significant difference in surgical time, intraoperative blood loss, anesthesia time, and remifentanil dosage between the two groups (all P>0.05); The dosage of propofol in the observation group was (880.41±41.06)mg, significantly lower than that in the control group ( P<0.05). The mean arterial pressure (MAP) and heart rate (HR) in the observation group were significantly higher than those in the control group at 5 minutes (T 1) and 30 minutes (T 2) after anesthesia (all P<0.05); The local cerebral oxygen saturation (rSO 2) and bispectral index (BIS) of the observation group at T 1, T 2, and postoperative (T 3) were significantly higher than those of the control group (all P<0.05). The serum levels of IL-6, CRP, PCT, tumor necrosis factor α (TNF-α), and S-100b in the observation group at 24 hours postoperatively were (13.36±1.22)mg/L, (10.08±1.12)ng/L, (0.94±0.15)ng/ml, (11.15±1.26)ng/L, and (1 445.15±180.05)ng/L, respectively, significantly lower than those in the control group (all P<0.05). The MMSE score of the observation group at 24 hours post surgery was (25.78±1.02), significantly higher than that of the control group ( P<0.05). The incidence of postoperative cognitive impairment in the observation group and the control group was 4.44%(2/45) and 8.89%(4/45), respectively, with no statistically significant difference ( P=0.673). Conclusions:Anesthesia management based on cerebral oxygen saturation monitoring has a good application effect in elderly NSCLC radical surgery, with small fluctuations in patient hemodynamic indicators, which can inhibit inflammatory factor levels and have a mild impact on postoperative cognitive function.

Objective:To explore the clinical application of ultrasound-guided anterior serratus plane block (SAPB) in anesthesia and postoperative analgesia of thoracoscopic surgery and to provide theoretical basis for clinical practice.Methods:From June 2018 to June 2019, a total of 90 patients with thoracoscopic surgery in Nanhai District People's Hospital of Foshan were randomly divided into three groups, 30 cases in each group. Group A received routine general anesthesia; Group B received preoperative SAPB+ routine general anesthesia; Group C was treated preoperatively SAPB+ single dose of 1 μg/kg dexmedetomidine+ routine general anesthesia. The mean arterial pressure (MAP) and heart rate (HR) of the three groups were compared after entering the room, immediately after intubation, during skin incision and immediately after extubation. The intraoperative dosage of propofol and remifentanil, the effective pressing times of analgesic pump within 48 hours, the dosage of sufentanil, the level of analgesia, adverse reactions and satisfaction were compared.Results:There was no significant difference in MAP and HR of the three groups of patients when they entering the room ( P>0.05); the MAP and HR of the three groups at the time of intubation, skin incision and extubation were higher than those at the time of entry ( P<0.05); the MAP and HR of B group and C group were lower than group A at the time of intubation, skin incision and extubation (all P<0.05). There was no significant difference in the intraoperative doses of remifentanil and propofol among the three groups (all P>0.05). The effective pressing times of analgesic pump and the dosage of sufentanil in group B and group C within 48 hours were lower than those in group A (all P<0.05). The pain scores in resting state and cough state at 2, 4, 12 and 24 hours after operation in group C were lower than those in group B and group A (all P<0.05). The incidence of postoperative adverse reactions in group B and group C was lower than that in group A (all P<0.05). The postoperative satisfaction of group B and group C was higher than that of group A (all P<0.05). Conclusions:SAPB guided by ultrasound combined with general anesthesia and single dose of dexmedetomidine can effectively improve hemodynamic indexes, relieve pain, and have high safety and satisfation in patients undergoing thoracoscopic surgery. The treatment effect is significant and can be widely used in clinical practice.

A 68-year-old female patient with rheumatic heart disease and auricular fibrillation received warfarin (10.5 mg per week, totally 6 weeks;then 12 mg per week, totally 3 weeks).The international nomalized ratio (INR) was monitored regularly.Her INR was steady and reached the standard during the medication.She took Zhisou Lixiao Wan 12 g daily by herself because of cough on the 10th week.Four days later she found multiple ecchymosis at her front of right leg and the INR was 6.46.Warfarin was withdrawn while Zhisou Lixiao Wan was continued.Three days later, the ecchymosis was absorbed obviously and the INR decreased to 2.96.Zhisou Lixiao Wan was stopped and warfarin was taken by 12 mg weekly.Five days later, her INR was 2.24 and the ecchymosis disappeared completely.

A 68-year-old female patient with rheumatic heart disease and auricular fibrillation received warfarin (10.5 mg per week, totally 6 weeks;then 12 mg per week, totally 3 weeks).The international nomalized ratio (INR) was monitored regularly.Her INR was steady and reached the standard during the medication.She took Zhisou Lixiao Wan 12 g daily by herself because of cough on the 10th week.Four days later she found multiple ecchymosis at her front of right leg and the INR was 6.46.Warfarin was withdrawn while Zhisou Lixiao Wan was continued.Three days later, the ecchymosis was absorbed obviously and the INR decreased to 2.96.Zhisou Lixiao Wan was stopped and warfarin was taken by 12 mg weekly.Five days later, her INR was 2.24 and the ecchymosis disappeared completely.