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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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

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

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