局部浸润麻醉联合股神经阻滞对老年全膝关节置换术患者术后疼痛和认知功能的影响  

Effects of local infiltration anesthesia combined with femoral nerve block on pain and cognitive function in elderly patients after total knee arthroplasty

作　　者：董维华 卫红军 任国清[2] 周健[2] 刘志成[2] 陈松岩 张其亮 Dong Weihua;Wei Hongjun;Ren Guoqing;Zhou Jian;Liu Zhicheng;Chen Songyan;Zhang Qiliang(Qingdao University Medical College,Qingdao 266000,China;不详)

机构地区：[1]青岛大学医学部,青岛266000 [2]青岛大学附属青岛市市立医院骨关节与运动医学科二病区 [3]青岛大学附属青岛市市立医院病理科

出　　处：《中国临床保健杂志》2023年第5期638-641,共4页Chinese Journal of Clinical Healthcare

基　　金：山东省青岛市医药科研指导计划资助项目(2019-WJZD020)。

摘　　要：目的 探讨局部浸润麻醉(LIA)联合超声引导下股神经阻滞(CFNB)对老年全膝关节置换术(TKA)患者术后疼痛和认知功能的影响。方法 选择2021年11月至2023年1月在青岛大学附属青岛市市立医院行TKA的老年患者120例,按照随机数字表法分成观察组(60例)及对照组(60例)。对照组采用LIA,观察组在此基础上联合超声引导下的CFNB。比较2组患者术前及术后1、3、5 d时的视觉疼痛模拟评分法(VAS)评分、认知功能[简易智能状态量表(MMSE)评分、蒙特利尔认知功能量表(MoCA)评分];比较2组术前及术后3 d时的人轻肽神经丝蛋白(NEFL)、磷酸化神经丝H(pNF-H)、P物质(PS)、5-羟色胺(5-HT)、白细胞介素(IL)-6及肿瘤坏死因子(TNF)-α水平。结果 术前1 d时,2组的VAS评分、MMSE评分、MoCA评分、NEFL、pNF-H、IL-6、TNF-α、PS、5-HT比较,差异均无统计学意义(P>0.05);术后1、3、5 d时,2组的VAS评分均高于术前1 d时(P<0.05),且观察组均低于对照组(P<0.05);术后5 d时,2组的MMSE评分、MoCA评分均低于术前1 d(P<0.05),而观察组均高于对照组(P<0.05);术后3 d时,2组的NEFL、pNF-H均高于术前1 d(P<0.05),观察组均低于对照组(P<0.05);术后3 d时,2组的IL-6、TNF-α、PS、5-HT均高于术前1 d(P<0.05),观察组均低于对照组(P<0.05)。结论 LIA联合CFNB可降低老年TKA术后炎症因子水平、抑制疼痛介质的释放,缓解患者术后疼痛,有利于术后早期恢复认知功能。Objective To explore the effects of local infiltrating anesthesia(LIA)combined with ultrasound-guided continuous femoral nerve block(CFNB)on pain and cognitive function in elderly patients after total knee arthroplasty(TKA).Methods A total of 120 elderly patients undergoing TKA in Qingdao University Medical College were enrolled between November 2021 and January 2023.According to random number table method,they were divided into observation group(n=60)and control group(n=60).The control group was given LIA,while observation group was additionally given ultrasound-guided CFNB.The scores of Visual Analogue Scale(VAS)and cognitive function[mini-mental state examination(MMSE),Montreal cognitive assessment(MoCA)]before surgery and at 1d,3d and 5d after surgery,levels of human neurofilament light chain gene(NEFL),phosphorylated neurofilament H(pNF-H),substance P(PS),5-hydroxytryptamine(5-HT),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)before and at 3 d after surgery were compared between the two groups.Results At 1 d before surgery,there were no significant difference in VAS score,MMSE score,MoCA score,NEFL,pNF-H,IL-6,TNF-α,PS or 5-HT levels between the two groups(P>0.05).At 1 d,3 d and 5 d after surgery,VAS scores were higher than those at 1 d before surgery in the two groups(P<0.05),and which were lower in observation group than control group(P<0.05).At 5 d after surgery,MMSE and MoCA scores were lower than those at 1 d before surgery in the two groups(P<0.05),and which were higher in observation group than those in control group(P<0.05).At 3 d after surgery,NEFL and pNF-H were higher than those at 1 d before surgery in the two groups(P<0.05),and which were lower in observation group than control group(P<0.05).At 3 d after surgery,levels of IL-6,TNF-α,PS and 5-HT were higher than those at 1 d before surgery in the two groups(P<0.05),and which were lower in observation group than control group(P<0.05).Conclusions LIA combined with CFNB can reduce levels of inflammatory factors,inhibit the release of pain

关 键 词：关节成形术 置换 膝 麻醉 局部 神经传导阻滞 股神经 疼痛 认知 

分 类 号：R614[医药卫生—麻醉学]