髂筋膜阻滞与自控静脉泵镇痛对老年髋部骨折术后认知功能的影响  

Effect of fascia iliaca compartment block and patient-controlled intravenous analgesia on postoperative cognitive function of elderly patients with hip fractures

作　　者：刘娟[1] 张波[1] 孙晓莉[1] 唐灵芝[1] 秦敏[1] 阮超 陈明[2] LIU Juan;ZHANG Bo;SUN Xiao-li;TANG Ling-zhi;Qin Min;RUAN Chao;CHEN Ming(Shangluo Central Hospital,Shangluo 726000;Orthopedics Department,Shaanxi Provincial People＇s Hospital,Xi＇an 710068,China)

机构地区：[1]商洛市中心医院,陕西商洛726000 [2]陕西省人民医院骨科,陕西西安710068

出　　处：《临床医学研究与实践》2018年第21期9-11,共3页Clinical Research and Practice

基　　金：陕西省卫生厅青年科研基金项目(2018年)(No.2012E9)

摘　　要：目的比较髂筋膜阻滞(FICB)与自控静脉泵镇痛(PCIA)两种镇痛方式对老年髋部骨折患者术后认知功能的影响。方法将我院100例老年髋部骨折手术患者随机分为FICB组(给予FICB镇痛)与PCIA组(给予PCIA镇痛),各50例。比较两组术后认知功能障碍(POCD)发生率,采用Logistic多因素回归分析筛检导致POCD的高危因素。结果术后患者POCD总发生率为34.0%(34/100),FICB组POCD发生率为22.0%,明显低于PCIA组的46.0%(P<0.05)。Logistic回归分析结果显示,心脑血管合并症、髋关节置换术及PCIA镇痛方式是发生POCD的独立危险因素(P<0.05)。结论 FICB可降低髋部骨折术后POCD的发生率,术前合并症多及选择髋关节置换术增加髋部骨折术后患者发生认知功能损害风险。Objective To compare the effects of fascia iliaca compartment block （FICB） and patient-controlled intravenousanalgesia （PCIA） on postoperative cognitive function of elderly patients with hip fractures. Methods A total of 100 elderlypatients with hip fractures in our hospital were randomly divided into FICB group （treated with FICB analgesia） and PCIAgroup （treated with PCIA）, with 50 cases in each group. The incidences of postoperative cognitive dysfunction （POCD）were compared between the two groups. High risk factors of POCD were analyzed by Logistic multivariate regression.Results The overall incidence of postoperative POCD was 34.0% （34/100）, and the incidence of POCD of the FICB groupwas 22.0%, which was significantly lower than 46.0% of the PCIA group （P〈0.05）. Logistic regression analysis showedthat cardiovascular complications, hip arthroplasty and PCIA analgesia were the independent risk factors for POCD （P〈0.05）. Conclusion FICB can reduce the incidence of POCD after hip fracture surgery. Preoperative multiple complicationsand hip arthroplasty can increase the risk of cognitive dysfunction after hip fracture surgery.

关 键 词：髋部骨折 老年人 髂筋膜阻滞(FICB) 自控静脉泵镇痛(PCIA) 术后认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]