髂筋膜间隙阻滞联合浅全麻对老年髋骨骨折手术患者围术期皮质醇、促肾上腺皮质激素浓度和术后睡眠质量的影响  

Effect of fascia iliac compartment block combined with shallow general anesthesia on perioperative concentrations of cortisol and adrenocorticotrophic hormone and postoperative sleep quality in elderly patients undergoing hip fracture surgery

作　　者：阮倩 自华芬 陈莉 杨平亮 Ruan Qian;Zi Huafen;Chen Li;Yang Pingliang(Department of Anesthesiology,First Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan,610500,P.R.China)

机构地区：[1]成都医学院第一附属医院麻醉科,四川成都610500

出　　处：《老年医学与保健》2021年第4期838-842,共5页Geriatrics & Health Care

基　　金：四川省教育厅科研项目(18ZA0158)。

摘　　要：目的探究髂筋膜间隙阻滞(FICB)联合浅全麻对老年髋骨骨折手术患者围术期皮质醇(COR)、促肾上腺皮质激素浓度(ACTH)和术后睡眠质量的影响,为治疗该病症提供方法。方法选择2019年1月-2020年12月成都医学院第一附属医院收治的116例老年髋骨骨折患者,根据随机数字表法分组为对照组56例和观察组60例,均接受髋关节置换术治疗。对照组采用全麻,观察组采用FICB联合浅全麻,记录患者入室时(T0)1切皮后5 min(T1)、扩张髓腔时(T2)、拔管即刻(T3)、术后30 min(T4)的血流动力学,分析2组患者手术情况、血流动力学、COR和ACTH浓度、术后疼痛及睡眠质量的差异。结果2组手术时间、术中出血量、输液量和术后不良反应比较差异无统计学意义(P>0.05),观察组术中麻醉药物用量和术后静脉自控镇痛泵用量均少于对照组(P<0.05);手术过程中,对照组T2、T3时和观察组T3时的平均动脉压(MAP)水平均高于同组T0时(P<0.05),2组T1、T2时的心率(HR)水平均低于T0时(P<0.05),T1~T3时,观察组的MAP均低于对照组(P<0.05),HR均高于对照组(P<0.05);术后24 h内,2组COR、ACTH浓度均增加(P<0.05),疼痛评分呈现降低趋势(P<0.05),且观察组术后12 h、24 h的COR、ACTH浓度和术后6 h、12 h、24 h的疼痛评分均低于对照组(P<0.05);术后7 d内,2组匹兹堡睡眠质量指数(PSQI)评分呈降低趋势(P<0.05),且观察组术后1 d、3 d的PSQI评分均低于对照组(P<0.05)。结论FICB联合浅全麻在老年髋骨骨折手术中能够有效抑制围术期应激反应,改善术后疼痛情况,提高患者术后睡眠质量,具有一定临床应用价值。Objective To explore the effect of fascia iliac compartment block(FICB)combined with shallow general anesthesia on perioperative concentrations of perioperative cortisol(COR)and adrenocorticotrophic hormone(ACTH)and postoperative sleep quality in elderly patients undergoing hip fracture surgery,and to provide the treatment method for this disease.Methods A total of 116 elderly patients with hip fractures who were treated in the First Affiliated Hospital of Chengdu Medical College between January 2019 and December 2020 were selected and divided into control group(56 cases)and observation group(60 cases)according to the random number table method.All patients received hip arthroplasty.The control group received general anesthesia,and the observation group was given FICB combined with shallow general anesthesia.The hemodynamics were recorded at entering the room(T0),at 5 min after skin incision(T1),at medullary cavity expansion(T2),immediately after extubation(T3)and at 30 min after surgery(T4).The differences of operation indexes,hemodynamics,concentrations of COR and ACTH,postoperative pain and sleep quality between the two groups were analyzed.Results There were no statistical differences in surgical time,intraoperative blood loss,infusion volume and postoperative adverse reactions between the two groups(P>0.05).The intraoperative anesthetic dosage and postoperative PCIA pump dosage in the observation group were less than those in the control group(P<0.05).During surgery,mean arterial pressure(MAP)at T2 and T3 in the control group and at T3 in the observation group were higher than those at T0 in the same group(P<0.05),and heart rate(HR)at T1 and T2 in both groups were lower than those at T0 in the same group(P<0.05).At T1~T3,the MAP of observation group was lower than that of control group(P<0.05),while the HR was higher than that of control group(P<0.05).Within 24 h after surgery,the concentrations of COR and ACTH in the two groups were increased(P<0.05),and the pain score showed a decreasing trend(P<0.05);and

关 键 词：老年 髋骨骨折 髂筋膜间隙阻滞 浅全麻 皮质醇 促肾上腺皮质激素 睡眠质量 

分 类 号：R614[医药卫生—麻醉学]