超声引导下不同神经阻滞对老年髋关节置换术后炎症因子及认知功能的影响  

Effects of different nerve blocks under ultrasound guidance on inflammatory factors and cognitive function after total hip replacement in the elderly

作　　者：夏海禄 柳洁 刘新 崔静静[1] 王建华 井郁陌[1] XIA Hai-lu;LIU Jie;LIU Xin;CUI Jing-jing;WANG Jian-hua;JING Yu-mo(Department of Anesthesia and Perioperative Medicine,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province,Cangzhou Hebei 061000,China)

机构地区：[1]河北省沧州中西医结合医院麻醉与围术期医学科,河北沧州061000

出　　处：《局解手术学杂志》2025年第3期223-227,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：2023年度河北省医学科学研究课题计划(20232148)。

摘　　要：目的探讨超声引导下不同神经阻滞对老年髋关节置换术后炎症因子表达的影响及其与术后认知功能障碍(POCD)的相关性。方法选取2023年2~11月于我院行人工髋关节置换术的100例老年患者作为研究对象,根据术中不同神经阻滞方式分成股神经阻滞(FNB)组和髋关节囊周围神经阻滞(PNGB)组。比较2组患者术前1 d、麻醉后6 h、术后1 d、术后3 d的血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、肿瘤坏死因子-β(TNF-β)等炎症因子的表达,采用简易精神状况(MMSE)评分评估患者认知功能状况,采用疼痛视觉模拟量表(VAS)评分评估患者疼痛情况。采用GEE模型评价两种神经阻滞对炎症因子表达的影响。Logistic回归分析患者术后炎症因子与POCD的相关性。结果PNGB组患者术后1 d的IL-1β、IL-6、IL-10、TNF-α、TNF-β水平均高于FNB组,差异具有统计学意义(P<0.05)。PNGB组患者术后1 d的MMSE评分显著高于FNB组(P<0.05),术后3 d的VAS评分显著低于FNB组(P<0.05)。GEE模型显示,PNGB对IL-1β、IL-6、IL-10、TNF-α、TNF-β的影响较大。IL-1β、IL-6、IL-10、TNF-α、TNF-β均是2种不同神经阻滞引发POCD的独立危险因素(P<0.05)。结论PNGB能够更有效地抑制促炎因子,减轻炎症应激反应,维持炎症因子平衡。炎症因子与不同神经阻滞引发的POCD均独立相关,随着炎症应激反应的发生,患者发生POCD的风险增加。Objective To explore the effects of different nerve blocks under ultrasound guidance on the expression of inflammatory factors after total hip replacement in the elderly,and its correlation with postoperative cognitive dysfunction(POCD).Methods A total of 100 elderly patients who underwent total hip replacement in our hospital from February to November 2023 were selected as the research objects,and they were divided into the femoral nerve block(FNB)group and the pericapsule nerve group block(PNGB)group according to different nerve block methods during the operation.The expression of inflammatory factors such as serum interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and tumor necrosis factor-β(TNF-β)1 day before surgery,6 hours after anesthesia,1 day after surgery,and 3 days after surgery of patients in the two groups were compared.The cognitive function of patients was evaluated by the mini-mental state examination(MMSE)score,and the pain of patients was evaluated by visual analogue scale(VAS)score.GEE model was used to evaluate the effects of two kinds of nerve block on the expression of inflammatory factors.Logistic regression was used to analyzed the correlation between postoperative inflammatory factors and POCD in patients.Results The levels of IL-1β,IL-6,IL-10,TNF-αand TNF-β1 day after operation in the PNGB group were higher than those in the FNB group,and the differences were statistically significant(P<0.05).The MMSE score 1 day after surgery in the PNGB group was significantly higher than that in the FNB group(P<0.05),and the VAS score 3 days after surgery was significantly lower than that in the FNB group(P<0.05).GEE model showed that PNGB has a greater impact on IL-1β,IL-6,IL-10,TNF-α,and TNF-β.IL-1β,IL-6,IL-10,TNF-α,and TNF-βwere all independently related to POCD induced by two different nerve blocks(P<0.05).Conclusion PNGB can effectively inhibit pro-inflammatory factors,reduce inflammatory stress responses,and maintain the balance of inflam

关 键 词：神经阻滞 全髋关节置换术 炎症因子 认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]