麻醉方式影响膝关节置换术后炎症因子及认知功能  

Effect of two anesthesia methods on inflammatory factors and cognitive function in patients undergoing knee replacement

作　　者：赵志宏[1] 赖德华[2] 黎秀萍[1] 岑燕遗[1] 袁晴[3] 董庆龙[1] Zhao Zhihong;Lai Dehua;Li Xiuping;Cen Yanyi;Yuan Qing;Dong Qinglong(Anesthesia Department,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;General surgery,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Clinical Laboratory,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州医科大学附属第一医院麻醉科,510120 [2]广州医科大学附属第一医院普通外科,510120 [3]广州中医药大学附属第一医院检验科,510405

出　　处：《中华关节外科杂志（电子版）》2019年第6期765-768,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨两种麻醉方式对膝关节置换术患者炎症因子和认知功能的影响。方法选择2016年1月至2019年5月在广州医科大学附属第一医院行膝关节置换术的患者40例,年龄61~75岁,排除术前有精神认知障碍的患者。数字随机法分为研究组和对照组各20例。研究组采用喉罩全麻联合股神经阻滞,对照组选用静吸复合全身麻醉。测定术前及术后24 h肿瘤坏死因子(TNF)-α和白细胞介素(IL)-6水平进行比较,观察并记录患者麻醉后监测治疗室(PACU)复苏情况,并使用简易精神状况检查量表(MMSE)评价认知功能。上述数据比较均采用t检验。结果研究组术后24 h TNF-α和IL-6测值明显低于对照组(t=10.025、8.117,P<0.05);研究组患者术后拔管时间和PACU总停留时间显著短于对照组(t=8.943、11.307,P<0.05);研究组术后1 d和3 d的MMSE分值显著高于对照组(t=6.68、5.89,P<0.05);而两组之间术前和术后7 d的MMSE分值差异无统计学意义(P>0.05)。结论对于行膝关节置换术,喉罩静脉全麻联合股神经阻滞可以降低炎症因子水平,促进快速康复,改善患者术后短期认知功能障碍,是一种值得临床推广应用的麻醉方法。Objective To investigate the effects of two anesthesia methods on inflammatory factors and cognitive function in patients undergoing knee replacement.Methods From January 2016 to May 2019,40 patients over 60 years old who underwent knee replacement in the First Affiliated Hospital of Guangzhou Medical University were randomly divided into the study group and the control group,20 patients each.The patients with preoperative mental impairment were excluded.The study group were treated with laryngeal mask general anesthesia combined with femoral nerve block,and the control group were treated with general anesthesia.The serum levels of tumor necrosis factor(TNF)-αand interleukin(IL)-6 were compared before operation and at the postoperative 24 h,the postanesthesia care unit(PACU)recovery time of all patients were observed and recorded,and the mini-mental state examination(MMSE)scale wasused to evaluate the cognitive function in the two groups before operation and postoperative 1,3 and 7 d.All the data were compared using t test.Results The levels of TNF-α、IL-6 of the study group were lower than that in control group at 24 h postoperation(t=10.025、8.117,P<0.05);the time of extubation and the residence time of PACU in the study group were significantly shorter than those in the control group(t=8.943、11.307,P<0.05).MMSE score of the study group was higher than the control group on the postoperative 1,3 and 7 d(t=6.68、5.89,P<0.05),while it showed no significant difference between the two groups before the surgery and 7d after the surgery(P>0.05).Conclusion For the patients undergoing knee replacement,laryngeal mask general anesthesia combined with femoral nerve block can decrease the levels of inflammatory factors,promote rapid recovery,and improve the postoperative cognitive disfunction in short period,which is worthy of further clinical application.

关 键 词：麻醉 全身 神经阻滞 认知障碍 炎症 细胞因子类 

分 类 号：R47[医药卫生—护理学]