联合神经阻滞对急性脑梗死患者髋关节置换术后转归的影响  

Impact of combined nerve blocks on the outcome of hip replacement in elderly patients with acute cerebral infarction

作　　者：侯家保[1] 万杏[1] 赵博[1] 魏晓冬[1] 夏中元[1] 吴洋[1] Hou Jiabao;Wan Xing;Zhao Bo;Wei Xiaodong;Xia Zhongyuan;Wu Yang(Department of Anesthesiology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院麻醉科,武汉430060

出　　处：《中华医学杂志》2021年第25期1968-1972,共5页National Medical Journal of China

基　　金：国家自然科学基金(82001119);湖北省自然科学基金(2020CFB224,2017CFB267);武汉大学人民医院引导基金(RMYD2018M03)。

摘　　要：目的探讨腰丛、坐骨和L1椎旁联合神经阻滞在急性脑梗死老年患者合并股骨颈骨折行人工髋关节置换手术中的应用及对患者术后转归的影响。方法回顾性分析武汉大学人民医院2013年5月至2018年9月114例急性脑梗死合并股骨颈骨折行人工髋关节置换手术老年患者的临床资料,根据麻醉方式分为两组:全身麻醉组(G组,n=48),超声引导下腰丛、坐骨和L1椎旁联合神经阻滞组(N组,n=66)。比较分析两组患者手术时间、麻醉时间、出血量、尿量和去甲肾上腺素使用量,术后重症监护病房(ICU)停留时间,住院期间和术后6个月死亡率,术前1 d及术后1、3、7 d的患者简易智力状态检查量表(MMSE)评分、美国国立卫生研究院卒中量表(NIHSS)评分和血浆D-二聚体、中枢神经特异性蛋白(S100β)水平。结果两组患者术前一般资料、手术时间、麻醉时间、出血量及ICU停留时间差异均无统计学意义(均P>0.05)。G组患者术中去甲肾上腺素用量、尿量、住院期间死亡率、术后6个月死亡率分别为(184±28)μg、(160±55)ml、25.0%(12/48)、31.3%(15/48),N组上述指标分别为(86±23)μg、(265±58)ml、7.6%(5/66)、12.1%(8/66),与G组相比,N组患者术中去甲肾上腺素的用量减少,尿量增加,住院期间死亡率及术后6个月死亡率下降(均P<0.01)。G组患者术后3 d的MMSE评分、NIHSS评分、血浆D-二聚体、S100β水平分别为(9.9±3.0)分、(15.3±3.2)分、(10.8±2.5)mg/L、(326±35)ng/L,N组患者分别为(14.6±2.4)分、(9.9±3.5)分、(7.3±2.2)mg/L、(276±29)ng/L,N组患者术后3 d的MMSE评分高于G组,NIHSS评分、血浆D-二聚体和S100β水平均低于G组(均P<0.01)。结论联合神经阻滞可降低急性脑梗死患者行人工髋关节置换手术后死亡率,改善脑功能及预后。Objective To investigate the impact of ultrasound-guided lumbar plexus,sciatic nerve and L1 paravertebral combined nerve blocks on the outcomes of elderly acute cerebral infarction patients with femoral neck fracture who underwent hip replacement.Methods The clinical data of 114 elderly acute cerebral infarction patients with femoral neck fracture and underwent artificial hip replacement surgery from May 2013 to September 2018 in Renmin Hospital of Wuhan University were retrospectively analyzed.The patients were divided into two groups based on the different anesthetic methods they received:general anesthesia(G group,n=48),lumbar plexus,sciatic nerve and L1 paravertebral combined nerve blocks(N group,n=66).The operation time,anesthesia time,blood loss,urine volume,norepinephrine dose,length of intensive care unit(ICU)stay,hospital mortality and postoperative 6-month mortality were observed and compared between the two groups.The mini-mental state examination(MMSE)scores and the national institute of health stroke scale(NIHSS)scores were evaluated,respectively.Meanwhile,plasma D-Dimer and S100βlevels were measured 1 d before surgery,3 d and 7 d after surgery.Results There were no significant differences in the baseline characteristics,operation time,anesthesia time,blood loss and length of ICU stay between the two groups(all P>0.05).Compared with group G,the dosage of norepinephrine[(86±23)μg vs(184±28)μg],hospital mortality[7.6%(5/66)vs 25.0%(12/48)]and postoperative 6-month mortality[12.1%(8/66)vs 31.3%(15/48)]were significantly decreased in group N,while the urine volume[(265±58)ml vs(160±55)ml]was significantly increased(all P<0.01).The MMSE scores(9.9±3.0 vs 14.6±2.4)in group N were significantly higher than those in the group G 3 d after surgery,while the NIHSS scores(15.3±3.2 vs 9.9±3.5),plasma D-Dimer[(10.8±2.5)mg/L vs(7.3±2.2)mg/L]and S100βlevels[(326±35)ng/L vs(276±29)ng/L]were significantly lower than those in group G(all P<0.01).Conclusion Combined nerve blocks can reduce the mortality

关 键 词：脑梗死 关节成形术 置换 髋 麻醉 全身 联合神经阻滞 认知 

分 类 号：R614[医药卫生—麻醉学]