连续髂筋膜间隙阻滞对老年全髋关节置换术患者围手术期炎症反应及认知功能的影响  

Effect of continuous fascia iliaca compartment block on perioperative inflammatory response and cognitive function in elderly patients with total hip replacement

作　　者：任立文 罗紫苏 罗文俊 李斌 胡惠英 汪婷婷 孙巧玲 吴坛光 李书庭 Ren Liwen;Luo Zisu;Luo Wenjun;Li Bin;Hu Huiying;Wang Tingting;Sun Qiaoling;Wu Tanguang;Li Shuting(Department of Anesthesiology,General Hospital of Central Theater Command,Wuhan Hubei 430010,China;Hubei Medical College,Shiyan Hubei 442000,China)

机构地区：[1]中部战区总医院麻醉科,湖北武汉430010 [2]湖北医药学院,湖北十堰430070

出　　处：《中国医刊》2024年第11期1233-1236,共4页Chinese Journal of Medicine

基　　金：湖北省自然科学基金计划项目(2024AFB539)。

摘　　要：目的探讨连续髂筋膜间隙阻滞对老年全髋关节置换术患者围手术期炎症反应及认知功能的影响。方法选取2021年7月1日至2023年12月31日中部战区总医院收治的90例行全髋关节置换术的老年髋部骨折患者为研究对象,采用随机数字表法分为对照组和观察组,每组45例。对照组患者入院后给予曲马多缓释片,观察组患者入院后给予连续髂筋膜间隙阻滞,两组患者均在入院后24~48h行全髋关节置换术。比较分析两组患者术前12h及术后6、12、24、48h的疼痛程度[视觉模拟评分法(VAS)评分]。比较分析两组患者术前1d及术后1、3d的认知功能[简易精神状态量表(MMSE)评分、神经行为认知状态检查表(NCSE)评分]及炎症因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、γ干扰素(IFN-γ)、中枢神经特异性蛋白β(S100β)]水平。比较分析两组患者的术后不良反应发生情况。结果术前12 h及术后6、12、24、48h,观察组患者的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。术前1d,两组患者的MMSE评分比较差异无统计学意义(P>0.05),而观察组患者的NCSE评分高于对照组,差异有统计学意义(P<0.05);术后1、3d,观察组患者的MMSE评分、NCSE评分均高于对照组,差异均有统计学意义(P<0.05)。术前1d及术后1、3d,观察组患者的IL-6、TNF-α、IFN-γ、S-100β水平均低于对照组,差异均有统计学意义(P<0.05)。观察组患者的术后不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论术前采用连续髂筋膜间隙阻滞可显著减轻老年全髋关节置换术患者围手术期的疼痛程度与炎症反应,有利于改善老年患者术后早期的认知功能,且安全性较好。Objective To investigate the effects of continuous fascia iliaca compartment block on perioperative inflammatory response and cognitive function in elderly patients with total hip replacemen.Method 90 elderly patients with total hip replacement admitted to the General Hospital of Central Theater Command from July 1,2021 to December 31,2023 were selected as the study objects.They were divided into control group and observation group by random number table method,with 45 cases in each group.The control group was given tramadol sustained-release tablets after admission,and the observation group was given continuous fascia iliaca compartment block after admission.Patients in two groups underwent total hip replacement 24 to 48 hours after admission.The pain levels(VAS score)12 h before surgery and 6,12,24 and 48 h after surgery were compared between the two groups.The cognitive function(MMSE score,NCSE score)and levels of inflammatory factors(IL-6,TNF-α,IFN-γ,S100β)1 day before surgery and 1,3 days after surgery were compared between the two groups.The incidence of postoperative adverse reactions was compared between the two groups.Result The VAS scores in the observation group were lower than those in the control group 12 h before surgery and 6,12,24 and 48 h after surgery,with statistical significance(P<0.05).1 day before surgery,there was no significant difference in MMSE score between the two groups(P>0.05),while the NCSE score in the observation group was higher than that in the control group,with statistical significance(P<0.05).1,3 days after surgery,MMSE scores and NCSE scores in the observation group were higher than those in the control group,with statistical significance(P<0.05).The total incidence of postoperative adverse reactions in the observation group was lower than that in control group,with statistical significance(P<0.05).Conclusion Preoperative continuous fascia iliaca compartment block can significantly reduce perioperative pain and inflammatory response in elderly patients with total

关 键 词：连续髂筋膜间隙阻滞 全髋关节置换术 炎症反应 认知功能 

分 类 号：R614[医药卫生—麻醉学]