腰丛-坐骨神经阻滞复合七氟醚喉罩吸入对老年股骨颈骨折手术患者的麻醉效果及对脑氧代谢和术后认知功能的影响  

Anaesthetic effects of lumbar plexus-sciatic nerve block combined with sevoflurane for laryngeal mask inhalation and its influence on cerebral oxygen metabolism and postoperative cognitive function in elderly patients with femoral neck fractures

作　　者：刘坡 孔君花 Liu Po;Kong Junhua(Department of Anesthesiology,Zhengzhou Orthopaedics Hospital,Zhengzhou 450015,China)

机构地区：[1]郑州市骨科医院麻醉科,郑州450015

出　　处：《中国实用医刊》2022年第19期25-29,共5页Chinese Journal of Practical Medicine

摘　　要：目的观察腰丛-坐骨神经阻滞(LP-SNB)复合七氟醚喉罩吸入对老年股骨颈骨折手术患者的麻醉效果及对脑氧代谢和术后认知功能的影响。方法抽取2020年6月至2022年5月于郑州市骨科医院行人工股骨头置换术的老年股骨颈骨折患者98例,根据麻醉方案分为观察组(51例,采用LP-SNB复合七氟醚喉罩吸入麻醉)和对照组(47例,采用七氟醚喉罩吸入全身麻醉)。观察两组患者麻醉不同时刻心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉血压(MAP)的变化情况。记录两组患者麻醉阻滞起效时间、手术时间、术中出血量、苏醒时间及苏醒质量;观察两组麻醉诱导前后,手术开始时,术后15、30、60 min及手术结束后脑氧饱和度变化情况;记录术后认知功能障碍(POCD)发生率;记录两组患者不良事件发生情况。结果观察组麻醉阻滞起效时间和术后苏醒时间均短于对照组(P均<0.05)。观察组气管插管前即刻(T1)、插管后即刻(T2)时SBP高于对照组,T1时DBP、MAP、HR高于对照组(F组间=15.13,6.40,21.76,11.08,P均<0.05)。观察组手术开始时,术后15、30 min左、右侧脑氧饱和度高于对照组(F组间=30.01,31.41,P均<0.05)。观察组术后POCD发生率(13.73%,7/51)低于对照组(31.91%,15/47),χ^(2)=4.65,P=0.03。观察组围术期不良事件发生率(9.80%,5/51),与对照组(17.02%,8/47)比较差异未见统计学意义(χ^(2)=1.11,P=0.293)。结论LP-SNB复合七氟烷麻醉方案较七氟烷喉罩全身麻醉术中循环稳定性更好,脑氧代谢率更低,更能保护脑神经,降低POCD,且安全性较好。Objective To observe the anaesthetic effects of lumbar plexus-sciatic nerve block(LP-SNB)combined with sevoflurane for laryngeal mask inhalation,and its influence on cerebral oxygen metabolism and postoperative cognitive function in elderly patients with femoral neck fractures.Methods A total of 98 elderly patients with femoral neck fractures undergoing artificial femoral head arthrolasty in Zhengzhou Orthopaedics Hospital from June 2020 and May 2022 were selected.According to anesthesia methods,they were divided into observation group(51 cases,receiving LP-SNB combined with sevoflurane for laryngeal mask inhalation)and control group(47 cases,receiving general anesthesia with sevoflurane for laryngeal mask inhalation).The changes of heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)at different time points in the two groups were observed.The onset time of anesthesia block,operation time,intraoperative blood loss,recovery time and quality in both groups were recorded.The changes of cerebral oxygen saturation before and after anesthesia induction,at the start of surgery,15 min,30 min and 60 min after the start of surgery,and after surgery in the two groups were observed.The incidence of postoperative cognitive dysfunction(POCD)was recorded.The incidence of adverse events of the two groups were recorded.Results The onset time of anesthesia block and postoperative recovery time of the observation group were shorter than those of the control group(all P<0.05).The SBP in the observation group was higher than that in control group immediately before tracheal intubation(T1)and immediately after tracheal intubation(T2),while DBP,MAP and HR were higher than those in the control group at T1(Fbetween-group=15.13,6.40,21.76,11.08;all P<0.05).The left and right cerebral oxygen saturation in the observation group were higher than those in the control group at the start of surgery,15 min and 30 min after the start of surgery(Fbetween-group=30.01,31.41;all P<0.05).The incidenc

关 键 词：七氟醚 腰丛-坐骨神经阻滞 喉罩吸入 老年股骨颈骨折 脑氧代谢 术后认知功能 

分 类 号：R614[医药卫生—麻醉学]