髂筋膜神经阻滞联合气管插管全麻对老年髋关节置换术的认知功能及术后谵妄发生率影响  

The Effect of Iliac Fascial Nerve Block Combined with Tracheal Intubation General Anesthesia on Cognitive Function and Postoperative Delirium Incidence in Elderly Patients undergoing Hip Replacement Surgery

作　　者：黄嘉瑜 肖珍科 潘伶俐 陈洲 劳俊铭 HUANG Jia-yu;XIAO Zhen-ke;PAN Ling-li;CHEN Zhou;LAO Jun-ming(Department of Anesthesiology,Traditional Chinese Medicine Hospital Affiliated to Guangzhou Medical University,Guangzhou,Guangdong,510000,China)

机构地区：[1]广州医科大学附属中医医院麻醉科,广东广州510000

出　　处：《现代生物医学进展》2025年第5期884-892,共9页Progress in Modern Biomedicine

基　　金：广东省自然科学基金项目(2023A1515011117)。

摘　　要：目的:探讨髂筋膜神经阻滞联合气管插管全麻对老年髋关节置换术的认知功能及术后谵妄发生率影响。方法:前瞻性选取2021年12月至2024年3月收治的90例老年髋关节置换术患者,分为全麻组与联合组,各45例。全麻组实施常规气管插管全麻,主要以咪达唑仑、丙泊酚、顺式阿曲库铵、舒芬太尼及瑞芬太尼静注为主,联合组在气管插管全麻基础上增加髂筋膜神经阻滞,药物以罗哌卡因为主。比较两组麻醉前(T_(1)),插管即刻(T_(2)),假体植入即刻(T_(3)),手术结束即刻(T_(4))心率及平均动脉压变化;术后2 h、6 h、12 h、24 h、48 h视觉模拟量表(VAS)评分;手术前1 d、术后3 d肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)、白细胞介素-6(IL-6)水平;手术前1 d、术后1 d、3 d、5 d、7 d MMSE评分及谵妄发生率。结果:全麻组与联合组T_(1)、T_(4)时间心率、平均动脉压均对比无明显差异(P>0.05),全麻组T_(2)~T_(4)时间心率、平均动脉压均具有较大波动,而联合组T_(2)~T_(4)时间心率、平均动脉压波动较小,联合组T_(2)、T_(3)时间心率及平均动脉压水平低于全麻组(P<0.05);全麻组与联合组术后2 h、术后48 h VAS评分比较无明显差异(P>0.05),两组患者术后6 h~术后24 h VAS评分均降低,联合组降低幅度更大,联合组术后6 h、12 h及24 h VAS评分低于全麻组(P<0.05);全麻组与联合组手术前1 d TNF-α、IFN-γ、IL-6水平对比无明显差异(P>0.05),两组术后3 d TNF-α、IFN-γ、IL-6水平均升高,但联合组低于全麻组(P<0.05);全麻组、联合组手术前1 d、术后7 d MMSE评分对比无明显差异(P>0.05),联合组术后1 d、术后3 d MMSE评分较全麻组高(P<0.05),联合组术后谵妄发生率为6.67%低于全麻组28.89%(P<0.05)。结论:针对老年髋关节置换术患者应用髂筋膜神经阻滞联合气管插管全麻可改善术中心率和血压波动,减轻术后疼痛,降低术后炎症反应,同时优化术后认知功能并减�Objective:To explore the effect of fasiliac nerve block combined with general anesthesia of endotracheal intubation on cognitive function and postoperative incidence of elderly hip arthroplasty.Methods:90 elderly patients undergoing hip replacement surgery admitted from December 2021 to March 2024 were prospectively selected and randomly divided into a general anesthesia group and a combination group,with 45 patients in each group.The general anesthesia group received routine tracheal intubation general anesthesia,mainly with intravenous injection of midazolam,propofol,cisatracurium,sufentanil,and remifentanil.The combination group added iliac fascial nerve block on the basis of tracheal intubation general anesthesia,with ropivacaine as the main drug.Compare the changes in heart rate and mean arterial pressure between two groups before anesthesia(T_(1)),immediately after intubation(T_(2)),immediately after prosthesis implantation(T_(3)),and immediately after surgery(T_(4));Postoperative visual analogue scale(VAS)scores at 2,6,12,24,and 48 hours;The levels of tumor necrosis factor-α(TNF-α),interferon gamma(IFN-γ),and interleukin-6(IL-6)were measured on day 1 before surgery and day 3 after surgery;MMSE score and delusion incidence before 1 d,1 d,3 d,5 d and 7 after surgery.Results:There was no difference in heart rate and mean arterial pressure between the general anesthesia group and the combination group at T_(1) and T_(4)(P>0.05).The general anesthesia group showed fluctuations in heart rate and mean arterial pressure from T_(2) to T_(4),while the combination group had smaller fluctuations in heart rate and mean arterial pressure from T_(2) to T_(4).The heart rate and mean arterial pressure levels at T_(2) and T_(3) in the combination group were lower than those in the general anesthesia group(P<0.05);There was no difference in VAS scores between the general anesthesia group and the combination group at 2 hours and 48 hours after surgery(P>0.05).The VAS scores of both groups decreased from 6 to 24 hours after

关 键 词：髂筋膜神经阻滞 气管插管 全身麻醉 髋关节置换 认知功能 谵妄 

分 类 号：R3[医药卫生—基础医学] R614