超声引导下FICB阻滞对老年全髋关节置换术患者术后神经认知功能及炎症因子的影响  

Effects of ultrasound-guided fascia iliac compartment block on postperative neurocognitive function and inflammatory factors in elderly patients undergoing total hip arthroplasty

作　　者：王培培 赵志斌[1] 栾恒飞[1] 王平[1] 徐德明[1] WANG Pei-pei;ZHAO Zhi-bin;LUAN Heng-fei;WANG Ping;XU De-ming(Department of Anesthesiology,the First People's Hospital of Lianyungang,Lianyungang 222002,Jiangsu,China)

机构地区：[1]连云港市第一人民医院麻醉科,江苏连云港222002

出　　处：《川北医学院学报》2022年第2期209-212,共4页Journal of North Sichuan Medical College

基　　金：博士科研基金课题(BS202005)。

摘　　要：目的:探讨超声引导下髂筋膜间隙阻滞(FICB)对老年全髋关节置换术(THA)患者术后神经认知功能及炎症因子的影响。方法:按照术后镇痛方式不同将90例择期行THA术的患者分为观察组(n=45)与对照组(n=45);术后观察组行超声引导下FICB,穿刺置管后予以负荷量0.3%罗哌卡因30 mL,然后连接镇痛泵持续输注0.2%罗哌卡因;对照组使用经静脉患者自控镇痛。记录两组术后VAS评分、补救镇痛情况及不良反应等;并于术前1 d及术后1 d检测血清白细胞介素-6(IL-6)、IL-1β、肿瘤坏死因子-α(TNF-α)的表达水平,于术前及术后1、3、7 d进行简易精神状态评价量表(MMSE)评分以评定神经认知功能。结果:术后4、12、24、48 h,观察组的VAS评分低于对照组(P<0.05),且补救镇痛率低于对照组(P<0.05)。术后1 d,观察组血清IL-6、IL-1β、TNF-α水平均低于对照组(P<0.05)。术后1、3 d,观察组MMSE评分高于对照组,且PND发生率低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组(P<0.05)。结论:FICB能够有效减少老年THA患者术后神经认知功能障碍发生,减轻炎症反应可能是其作用机制之一。Objective:To investigate the effect of ultrasound-guided fascia iliaca compartment block(FICB)on postperative neurocognitive function and inflammatory factors in elderly patients undergoing total hip arthroplasty(THA).Methods:90 patients with THA were divided into observation group(n=45)and control group(n=45)according to different postoperative analgesia methods.After operation,the observation group received FICB under the guidance of ultrasound,after puncture and catheterization,the loading dose of 0.3%ropivacaine 30 ml was given,and then 0.2%ropivacaine was continuously infused through the analgesia pump.The Patient-controlled intravenous analgesia after operation was used in the control group.The postoperative VAS score,rescue analgesia and adverse reactions were recorded.The levels of interleukin-6(IL-6),interleukin-1(IL-1),tumor necrosis factor-α(TNF-α)were measured 1 day before operation and 1 day after operation,and the mini mental state assessment(MMSE)was used to evaluate the neurocognitive function 1 day before operation and 1,3,7 day after operation.Results:Compared with the control group,the VAS scores of the observation group at 4 h,12 h,24 h and 48 h after operation were lower(P<0.05),and the rescue analgesia rate was significantly lower(P<0.05).1 day after operation,the levels of IL-6,IL-1 and TNF-αin the observation group were significantly lower than those in the control group(P<0.05).The MMSE score of the observation group was higher than that of the control group on 1 and 3 d after operation,and the incidence of PND was lower than that of the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:FICB can effectively reduce the incidence of postoperative neurocognitive dysfunction in elderly patients undergoing THA,and reducing the inflammatory response may be one of the mechanisms.

关 键 词：全髋关节置换术 髂筋膜间隙阻滞 神经认知功能 炎症因子 老年 

分 类 号：R687.3[医药卫生—骨科学] R614.3[医药卫生—外科学]