早期使用髂筋膜间隙阻滞镇痛对髋部骨折患者术后早期认知的影响  

The effect of fascia iliaca compartment block continuous analgesia in the early stage on early postoperative cognitive in patients with hip fractures

作　　者：张岩 庞晓林 张东亚 Zhang Yan;Pang Xiaolin;Zhang Dongya(Department of Anesthesiology,the First Affiliated Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院麻醉科,北京100016

出　　处：《中国医师进修杂志》2023年第2期176-180,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的:探讨入院早期使用髂筋膜间隙阻滞(FICB)持续镇痛对老年髋部骨折患者术后早期认知与运动功能的影响。方法:选取2018年6月至2020年6月清华大学第一附属医院收治的老年髋部骨折患者80例,按随机数字表法分为对照组和观察组,每组40例。观察组入院后即刻采用FICB镇痛至手术前,两组术后均采用静脉镇痛48 h。比较两组患者视觉模拟量表(VAS)评分、简易精神状态评价量表(MMSE)评分、Harris评分以及手术指标、应激指标和不良反应发生情况。结果:观察组术后血糖、皮质醇、血管紧张素Ⅱ水平低于对照组[(5.21±1.03)mmol/L比(7.03±1.06)mmol/L、(643.08±77.28)nmol/L比(747.96±82.80)nmol/L、(41.03±5.22)ng/L比(57.15±8.16)ng/L],差异有统计学意义(P<0.05)。观察组术后盐酸曲马多用量低于对照组[(27.48±3.25)mg比(58.54±4.86)mg],差异有统计学意义(P<0.05)。观察组术前12 h、术后12 h、术后48 h时VAS评分低于对照组,MMSE评分高于对照组,差异有统计学意义(P<0.05)。观察组术后Harris评分高于对照组[(76.09±6.11)分比(65.62±6.13)分],差异有统计学意义(P<0.05)。观察组术后认知功能障碍发生率低于对照组[2.5%(1/40)比15.0%(6/40)],差异有统计学意义(χ2=3.91,P<0.05)。结论:老年髋部骨折患者入院后早期使用FICB镇痛可有效缓解患者术后疼痛,减轻应激反应,有利于术后认知功能与髋关节功能恢复。Objective To investigate the effect of fascial iliaca compartment block(FICB)continuous analgesia in the early stage after admission on early postoperative cognitive and motor function in elderly patients with hip fractures.Methods A total of 80 elderly patients with hip fractures admitted toThe First Affiliated Hospital of Tsinghua University from June 2018 to June 2020 were selected and randomly divided into the control group and the observation group,with 40 cases in each group.The control group adopted the routine postoperative analgesia regimen,while the observation group adopted FICB analgesia immediately after admission to the hospital until before the operation.Postoperative analgesia pattern was consistent with that of the control group,and both groups were given postoperative analgesia for 48 h.The scores of visual analogue scale(VAS),mini mental state assessment scale(MMSE),Harris hip score(Harris)and surgical indexes,stress indexes and incidence of adverse reactions were compared between the two groups.Results The levels of postoperative blood glucose,cortisol,angiotensinⅡin the observation group were lower than those in the control group:(5.21±1.03)mmol/L vs.(7.03±1.06)mmol/L,(643.08±77.28)nmol/L vs.(747.96±82.80)nmol/L,(41.03±5.22)ng/L vs.(57.15±8.16)ng/L,there were statistically differences(P<0.05).The dosage of sufentanil in the observation group was lower than that in the control group:(27.48±3.25)mg vs.(58.54±4.86)mg,there was statistically difference(P<0.05).The scores of VAS score at 12 h before surgery,12 h and 48 h after surgery in the observation group were lower than those in the control group,and the scores of MMSE score were higher than those in the control group,there were statistically differences(P<0.05).After the surgery,the Harris scores in the observation group was higher than that in the control group:(76.09±6.11)scores vs.(65.62±6.13)scores,there was statistically difference(P<0.05).The incidence rate of postoperative cognitive dysfunction(POCD)in the observation grou

关 键 词：髋骨折 老年人 认知障碍 运动障碍 髂筋膜间隙阻滞持续镇痛 

分 类 号：R614[医药卫生—麻醉学]