不同镇痛模式对老年髋部骨折围术期神经认知障碍的影响  

Effect of Different Analgesic Modes on Neurocognitive Impairment in Elderly Patients with Hip Fractures in Perioperative Period

作　　者：高辉 吕宝胜 屈梦瑶 夏德雨 刘海峰 贝冬雪 GAO Hui;LYU Baosheng;QU Mengyao;XIA Deyu;LIU Haifeng;BEI Dongxue(Hebei Yanda Hospital,Langfang,Hebei,China 065201)

机构地区：[1]河北燕达医院,河北廊坊065201

出　　处：《中国药业》2024年第S01期6-8,共3页China Pharmaceuticals

基　　金：河北省廊坊市科技支撑计划项目[2022013004]。

摘　　要：目的探讨不同镇痛模式对老年髋部骨折围术期神经认知障碍的影响。方法选取医院2022年4月至2024年3月收治的拟行髋部骨折术的老年患者180例,按镇痛模式的不同分为A组、B组、C组,各60例。A组、B组患者均予酮洛酸氨丁三醇注射液静脉注射,B组患者加用经静脉自控镇痛(PCIA)治疗;C组患者予单次腹股沟韧带上髂筋膜间隙阻滞术前镇痛。结果C组患者术后1 d(T_(1))、3 d(T_(2))蒙特利尔认知评估量表(MoCA)评分显著高于A组、B组(P<0.05);白细胞介素6、C反应蛋白水平显著低于A组、B组(P<0.05)。C组患者术后12,24,48,72 h的视觉模拟量表(VAS)评分显著低于A组、B组(P<0.05)。结论腹股沟韧带上髂筋膜间隙阻滞(神经阻滞)用于老年髋部骨折术围术期,更能缓解患者的应激反应及疼痛症状,降低术后认知功能障碍。Objective To investigate the effect of different analgesic modes on perioperative neurocognitive impairment in elderly patients with hip fractures.Methods A total of 180 elderly patients planned to undergo hip fracture surgery admitted to the hospital from April 2022 to March 2024 were selected and divided into the groups A,B and C according to different analgesic modes,with 60 cases in each group.The patients in the groups A and B were given intravenous injection of Ketorolac Tromethamine Injection,on this basis,the patients in the group B were treated with patient controlled intravenous analgesia(PCIA).The patients in the group C were given preoperative analgesia with a single iliac fascial space block on the inguinal ligament.Results The Montreal Cognitive Assessment(MoCA)scores on the 1st day(T_(1))and 3rd day(T_(2))after surgery in the group C were significantly higher than those in the groups A and B(P<0.05);the interleukin-6 and C-reactive protein levels were significantly lower than those in the groups A and B(P<0.05).The Visual Analogue Scale(VAS)scores in the group C at 12,24,48,72 h after surgery were significantly lower than those in the groups A and B(P<0.05).Conclusion The use of iliac fascial space block(nerve block)on the inguinal ligament during the perioperative period of elderly hip fracture surgery can better alleviate the patients′stress response and pain symptoms,and reduce postoperative cognitive dysfunction.

关 键 词：镇痛模式 髋部骨折 老年 围术期 神经阻滞 认知功能 

分 类 号：R971.2[医药卫生—药品]