超声引导下腰骶丛神经阻滞联合全麻对老年髋关节置换术病人术后谵妄的影响  

Effect of the ultrasound-guided lumbar plexus and sacral plexus nerve block combined with general anesthesia on the postoperative delirium in elderly patients treated with hip replacement surgery

作　　者：徐孟婷 张景俊[3] 刘倩影 陆松虹[3] 徐晖[3] XU Mengting;ZHANG Jingjun;LIU Qianying;LU Songhong;XU Hui(Bengbu Medical University,Bengbu Anhui 233030;Department of Anesthesiology,Affiliated Hospital of Jiaxing University,Jiaxing Zhejiang 314000;Department of Anesthesiology,The Third People′s Hospital of Bengbu,Bengbu Anhui 233003,China)

机构地区：[1]蚌埠医科大学,安徽蚌埠233030 [2]嘉兴大学附属医院麻醉科,浙江嘉兴314000 [3]安徽省蚌埠市第三人民医院麻醉科,233003

出　　处：《蚌埠医学院学报》2024年第5期610-614,618,共6页Journal of Bengbu Medical College

基　　金：蚌埠医学院自然科学研究项目(BYKY18181)。

摘　　要：目的:探讨超声引导下腰骶丛神经阻滞联合全麻对行髋关节置换术老年病人术后谵妄(POD)的影响。方法:选取髋关节置换术老年病人80例,随机分为腰骶丛神经阻滞联合全麻组(h组)和全麻组(q组),各40例。2组病人均采用喉罩通气,维持脑电双频指数40~60,术后静脉自控镇痛(PCA)。比较2组病人术中麻醉药物用量、手术相关指标;采用视觉模拟量表(VAS)评估病人术后疼痛情况;于术前(D0)、术后第1(D1)、3(D3)、7(D7)天分别测定病人意识模糊评估量表(CAM)评分,并抽取静脉血检测白细胞介素(IL)-1β、IL-6、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)和S100β蛋白水平。结果:与q组相比,h组病人术中麻醉药物用量、术后拔管时间、术后24 h PCA次数、术后各时间点VAS评分、首次下床时间及出院时间均明显减少(P<0.01);h组术后IL-1β、IL-6、TNF-α、CRP、S100β蛋白水平、CAM评分及POD发生率均明显低于q组(P<0.01)。结论:超声引导下腰骶丛神经阻滞联合全麻较单纯全麻,可减少行髋关节置换术的老年病人麻醉药用量,完善镇痛,降低炎性反应和POD发生率,有助于病人术后快速康复。Objective:To investigate the effects of ultrasound-guided lumbar plexus and sacral plexus nerve block combined with general anesthesia on postoperative delirium(POD)in elderly patients treated with hip replacement surgery.Methods:Eighty elderly patients treated with unilateral hip replacement were randomly divided to the lumbar plexus and sacral plexus nerve block combined with general anesthesia group(group h)and general anesthesia group(group q)(40 cases in each group).The laryngeal mask airway(LMA),maintaining the bispectral index(BIS)for 40-60 and postoperative intravenous controlled analgesia(PCIA)were performed in two groups.The amount of anesthetic drugs and related indexes of operation were compared between two groups.The visual analogue scale(VAS)was used to evaluate the postoperative pain.The CAM scores in two groups before operation(D0),on the day 1(D1),day 3(D3)and day 7(D7)were measured.The serum levels of interleukin(IL-1β),IL-6,tumor necrosis factorα(TNF-α),C-reactive protein(CRP)and S100βprotein were determined.Results:Compared with the group q,the intraoperative anesthetic dosage,postoperative extubation time,PCA frequency after 24 h of surgery,VAS score at each postoperative time point,first time out of bed and discharge time were significantly reduced in group h(P<0.01).After operation,the levels of IL-1β,IL-6,TNF-α,CRP,S100βprotein,CAM score and incidence rate of POD in group h were lower than those in group q(P<0.01).Conclusions:The ultrasound-guided lumbar plexus and sacral plexus nerve block combined with general anesthesia can reduce the dosage of anesthetics,degree of pain,inflammatory response and incidence rate of POD,and promote the postoperative rapid recovery in elderly patients treated with hip replacement surgery.

关 键 词：腰骶丛神经阻滞 全身麻醉 术后谵妄 髋关节置换术 

分 类 号：R614.2[医药卫生—麻醉学]