股神经阻滞对老年膝关节置换术后炎性反应与认知功能的影响  

Effects of femoral nerve block on postoperative inflammation response and cognitive function in elderly patients undergoing total knee arthroplasty

作　　者：罗振国[1] 肖莉[1] 吴刚[2] 董补怀[1] 吕建瑞[2] 薛荣亮[2] 

机构地区：[1]西安交通大学医学院附属红会医院麻醉科,西安710054 [2]西安交通大学第二附属医院麻醉科

出　　处：《山西医科大学学报》2016年第3期293-296,共4页Journal of Shanxi Medical University

摘　　要：目的探讨股神经阻滞对全麻下老年膝关节置换患者术后炎性反应与认知功能的影响。方法择期全麻下行膝关节置换术老年患者80例,年龄65-78岁,ASAⅠ或Ⅱ级,随机分为两组:单纯全麻组(n=40)与股神经阻滞复合全麻组(n=40)。均行气管插管全麻,股神经阻滞复合组麻醉诱导前在神经刺激仪引导下行股神经阻滞。分别于麻醉诱导后(T1),术后1 h(T2)、24 h(T3)、72 h(T4)采集静脉血测定血清IL-6、C-反应蛋白(CRP)水平。术前1 d,术后1,7 d均采用简易智能量表(MMSE)评估患者的认知水平,记录术后认知功能障碍(POCD)的发生情况。结果与T1时比较,T3时两组患者IL-6、CRP水平均明显升高(P<0.05)。与全麻组比较,T3时股神经阻滞复合组患者IL-6、CRP水平明显降低(P<0.05)。与术前比较,术后1 d两组患者的MMSE评分均明显降低,且全麻组明显低于股神经阻滞复合组(P<0.05)。股神经阻滞复合组术后1 d发生POCD明显少于全麻组(20.0%vs 50%P<0.05)。结论股神经阻滞可降低老年膝关节置换术患者术后炎性因子水平,降低POCD的发生。Objective To investigate the effects of femoral nerve block on postoperative inflammation response and cognitive function in elderly patients undergoing total knee arthroplasty under general anesthesia. Methods Eighty ASAⅠor Ⅱ patients,aged 65- 78 years,scheduled for elective total knee arthroplasty under general anesthesia,were randomly divided into two groups（ n = 40 in each group） ： general anesthesia group and general anesthesia combined femoral nerve block group（ combination group）. Operations were performed under general anesthesia with endotracheal tube. Patients received nerve block guided by nerve stimulator before induction of anesthesia in combination group. The blood samples were collected after anesthesia induction（ T1）,1 h（ T2）,24 h（ T3） and 72 h after operation（ T4） to determine serum concentrations of C-reactive protein（ CRP） and IL-6. Cognitive function was also evaluated at 1 d before surgery and 1 d,7 d after surgery by mini-mental state examination（ MMSE）. The incidence of postoperative cognitive dysfunction（ POCD） was recorded. Results The levels of IL-6 and CRP in both two groups were significantly increased at 1 d after operation compared with before surgery（ P〈0. 05）. Compared with general anesthesia group,the concentrations of CRP and IL-6 were significantly reduced at 24 h after operation in combination group（ P〈0. 05）. The MMSE scores declined at 1 d after operation in both groups,and the MMSE scores were lower in general anesthesia group（ P〈0. 05）. The incidence of POCD was significantly higher in general anesthesia group than in combination group at 1 d after operation（ 50. 0% vs 20. 0%,P〈0. 05）. Conclusion Femoral nerve block can reduce the postoperative inflammation response and the incidence of POCD in elderly patients undergoing total knee arthroplasty.

关 键 词：股神经阻滞 老年人 炎性反应 认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]