B超引导下腰丛-坐骨神经联合阻滞对股骨粗隆间骨折老年患者VEGF水平与认知功能的影响

doi:10.3969/j.issn.1006-6233.2020.09.019

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摘要 目的: 探究B超引导下腰丛-坐骨神经联合阻滞对股骨粗隆间骨折老年患者血管内皮细胞生长因子(VEGF)水平与认知功能的影响。方法: 选取2018年6月至2019年6月本院诊治的200例股骨粗隆间骨折老年患者为对象,按照随机数字表法并经简单随机分组成两组,分别为研究组(100例)与对照组(100例)。两组均采用人工股骨头置换术治疗,其中研究组术中采取B超引导下腰丛-坐骨神经联合阻滞麻醉,对照组术中采用蛛网膜下腔阻滞复合硬膜外麻醉。比较两种麻醉方式对老年股骨粗隆间骨折患者的VEGF水平与认知功能(MMSE)的影响。结果: 重复测量方差分析显示:两组MMSE评分、VEGF水平的时点、组间、时点与组别之间的交互效应差异均具有统计学意义(P<0.05)。且术后1d、术后3d及术后7d,研究组患者的MMSE评分及VEGF水平均较对照组高,组间差异有统计学意义(P<0.05)。同时两组患者术后1d、3d、7d的认知障碍发生率逐渐降低,研究组低于对照组,组间差异无统计学意义(χ²=2.606,P>0.05),时点差异具有统计学意义(χ²=9.988,P<0.05)。另两组术后均伴有恶心呕吐、尿潴留、头痛等不良反应,但研究组总发生率低于对照组,差异无统计学意义(χ²=2.000,P>0.05)。结论: B超引导下腰丛复合坐骨神经阻滞麻醉其起效较快,麻醉效果维持时间较长,可有效减轻老年股骨粗隆间骨折患者术中的疼痛感,降低老年患者术后认知障碍,且在一定程度上可促进VEGF分泌,对患者术后的康复具有积极作用。

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关键词 ：股骨粗隆间骨折, 腰丛-坐骨神经联合阻滞, 血管内皮细胞生长因子, 认知功

Abstract：Objective: To investigate the effect of B-ultrasound guided lower plexus - sciatic nerve combined block on vascular endothelial growth factor (VEGF) level and cognitive function in elderly patients with intertrochanteric fracture of femur.Methods: A total of 200 elderly patients with intertrochanteric fractures diagnosed and treated in our hospital from June 2018 to June 2019 were selected as the subjects.With the random number table method, they were randomly divided into two groups, namely the study group (100 cases) and the control group (100 cases).Artificial femoral head replacement was applied in both groups.In the study group, B-ultrasound guided lower plexus and sciatic nerve combined block anesthesia was applied, while in the control group, subarachnoid block combined with epidural anesthesia was applied.The effects of two anesthesia methods on VEGF level and MMSE in elderly patients with intertrochanteric fractures were compared .Results: Repeated measures analysis of variance showed that there were statistically significant differences in MMSE scores, VEGF levels at time points, between groups, and between time points and groups (P<0.05).In addition, MMSE score and VEGF level of the patients in the study group were higher than those in the control group 1d, 3d and 7d postoperatively, and the difference between the groups was statistically significant (P<0.05).At the same time, the incidence of cognitive impairment on 1d, 3d and 7d after the operation of the two groups gradually decreased, and the study group was lower than the control group.The difference between the two groups was not statistically significant (χ²=2.606, P>0.05), and the time point difference was statistically significant (χ²=9.988, P<0.05).The other two groups were accompanied by nausea, vomiting, urine retention, headache and other adverse reactions after surgery, but the total incidence of the study group was lower than that of the control group, with no statistical significance (χ²=2.000, P>0.05).Conclusion: B-ultrasound guided lower plexus combined with sciatic nerve block anesthesia has a faster onset and a longer duration of anesthetic effect, which can effectively reduce the intraoperative pain in elderly patients with intertrochanteric fracture, reduce postoperative cognitive impairment in elderly patients, and promote VEGF secretion to a certain extent, which has a positive effect on postoperative rehabilitation.

Key words： Intertrochanteric fracture Combined lumbar plexus-sciatic nerve block Vascular endothelial growth factor Cognitive function

基金资助:2016年四川省卫生和计划生育科研课题,(编号:16PJ207)

通讯作者: 袁卫国

引用本文:

齐佳杉, 袁卫国, 罗明, 张玉林, 张英娟. B超引导下腰丛-坐骨神经联合阻滞对股骨粗隆间骨折老年患者VEGF水平与认知功能的影响[J]. 河北医学, 2020, 26(9): 1487-1491.
QI Jiashan, YUAN Weiguo, LUO Ming, et al. Effect of B-Ultrasound Guided Lower Plexus and Sciatic Nerve Block on VEGF Level and Cognitive Function in Elderly Patients with Intertrochanteric Fracture of Femur. HeBei Med, 2020, 26(9): 1487-1491.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.09.019 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I9/1487

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