超声引导下外周神经阻滞麻醉对老年髋关节置换术患者认知功能应激反应和术后转归的影响

doi:10.3969/j.issn.1006-6233.2020.07.015

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摘要 目的:分析老年髋关节置换术中采用超声引导下外周神经阻滞麻醉对认知功能、应激反应和术后转归的影响。方法:将在我院接受老年髋关节置换术的92例患者随机分为对照组和实验组,各46例,对照组给予全麻,实验组给予超声引导下外周神经阻滞麻醉。通过简易智力状态检查量表(MMSE)调查患者术后认知功能情况,观察患者各个阶段白介素(IL-6)和皮质醇(COR)的水平变化评估应激反应,通过静脉自控镇痛(PCIA)用量、下床活动时间、拔管时间、住院时间评估术后转归效果,调查患者术后不良症状情况。结果:结果显示,实验组在术后6h和术后1d MMSE评分均高于对照组,差异较大具有统计学意义(P<0.05);实验组术后PCIA用量、下床活动时间、拔管时间、住院时间均低于对照组,差异较大具有统计学意义(P<0.05);实验组在T1至T4阶段IL-6和COR水平均低于对照组,差异较大具有统计学意义(P<0.05);实验组在头痛、呕吐、尿潴留等不良症状发生率上与对照组差异较小,无统计学意义(P>0.05)。结论:超声引导下外周神经阻滞麻醉应用于老年髋关节置换术中,对患者认知功能影响较小,减小应激反应,避免了不良症状,加快了术后转归,镇痛效果明显,应用价值较高。

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	钟长云
	赵天兰

关键词 ：髋关节置换术, 超声引导, 外周神经阻滞, 麻醉, 认知功能

Abstract：Objective: To analyze the effect of ultrasound-guided peripheral nerve block anesthesia on cognitive function, stress response and postoperative outcome in elderly patients undergoing hip replacement. Methods: 92 patients undergoing hip replacement in our hospital were randomly divided into control group and experimental group, 46 cases in each group. The control group was given general anesthesia, and the experimental group was given peripheral nerve block anesthesia under the guidance of ultrasound. The cognitive function of patients after operation was investigated by MMSE. The changes of interleukin-6 (IL-6) and cortisol (COR) levels at different stages were observed to evaluate the stress response. The outcome was evaluated by the dosage of intravenous controlled analgesia (PCIA), the time of getting out of bed, the time of extubation and the length of hospital stay. The adverse symptoms after operation were investigated. Results: The results showed that the MMSE scores of the experimental group was higher than those of the control group at 6 hours and 1 day after operation, and the difference was significant (P<0.05); the dosage of PCIA, time of getting out of bed, time of extubation and length of hospital stay in the experimental group was lower than those in the control group, and the difference was significant (P<0.05); the levels of IL-6 and COR in the first and fourth stages was lower than those in the control group, and the difference was significant(P<0.05); the incidence of adverse symptoms such as headache, vomiting and urinary retention in the experimental group was not significantly different from those in the control group (P>0.05). Conclusion: Ultrasound-guided peripheral nerve block anesthesia has little influence on cognitive function of elderly hip replacement patients, reduces stress response, avoids adverse symptoms, speeds up the outcome of surgery, has obvious analgesic effect and high application value.

Key words： Hip replacement Ultrasound-guided Peripheral nerve block Anesthesia Cognitive function

基金资助:四川省卫生计生委科研课题,(编号:16PJ012)

引用本文:

钟长云, 赵天兰. 超声引导下外周神经阻滞麻醉对老年髋关节置换术患者认知功能应激反应和术后转归的影响[J]. 河北医学, 2020, 26(7): 1115-1118.
ZHONG Changyun, ZHAO Tianlan. Research on the Effect of Ultrasound-guided Peripheral Nerve Block Anesthesia on Cognitive Function Stress Response and Outcome in Elderly Patients Undergoing Hip Replacement. HeBei Med, 2020, 26(7): 1115-1118.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.07.015 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I7/1115

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