单次坐骨神经联合连续股神经阻滞镇痛对膝关节置换术后谵妄发生率的影响

Single-injection Sciatic Nerve Block Combined Continuous Femoral Nerve Block Reduces the Incidence of Postoperative Delirium

目的比较单次坐骨神经阻滞联合连续股神经阻滞镇痛(CFNB)与连续股神经阻滞镇痛对膝关节置换术后谵妄发生率的影响。方法对拟行膝关节置换患者进行前瞻随机对照研究。术前1天行简易精神评分评估患者基础认知状态,术后谵妄评估采用精神错乱评估法。所有患者均行单次蛛网膜下腔阻滞,术中使用丙泊酚轻度镇静。腰麻完成后试验组在神经刺激器辅助下行单次坐骨神经阻滞,之后行连续股神经置管镇痛(CFNB)。对照组在腰麻完成后行CFNB。作为镇痛不足的补充措施,所有患者术后静脉连接镇痛泵。另外,比较试验组与对照组术后疼痛评分(数字疼痛分级法)和阿片类药物的用量。结果共有97例患者入选本研究。共有11例在术后3天内发生了谵妄,谵妄发生率为11.3%,其中试验组是4.1%,对照组为16.7%(P=0.028)。试验组患者术后24、48、72h的NRS评分明显低于对照组(P<0.01)。试验组患者72h舒芬太尼的消耗量和按压总次数明显低于对照组(P<0.01)。结论单次坐骨神经阻滞联合CFNB较CFNB降低了膝关节置换术后谵妄的发生率。

Objective To compare the effect of＂ single-injection sciatic nerve block combined continuous femoral nerve block with continuous femoral nerve block on incidence of postoperative delirium in older patients. Methods A prospective, random study was conducted in patients who underwent total knee replacement. Baseline cognitive function was assessed using Mini-Mental State Examination scores in the day before operation. Postoperative delirium was measured using the Confusion Assessment Method postoperatively. All of the patients received a spinal anesthesia and light propofol sedation during operation. Guided by a nerve stimulator, sciatic nerve block combined continuous femoral nerve block was performed in experimental group and continuous femoral nerve block was performed in control group after spinal anesthesia. All of＂ the patients received patient-controlled analgesia as adjuvant analgesia. In addition, pain levels（using numerical rating scale scores, NRS） and opioid use were compared in two groups. Results 97 patients were studied. The overall incidence of postoperative delirium was 11.3% in 72h after operation. Incidenceof postoperative delirium in experimental group was lower than control group（4.1% vs. 16.7%, P=0.028）. There was significantly less NRS in experimental group comparing control group at rest 24,48 and 72h after surgery（P〈0.01）. The postoperative sufentanil consumption and PCA button press times in control group were more than that of experi- mental group（P 〈0.01） at 72h after operation. Conclusion Single-injection sciatic nerve block combined continuous femoral nerve block reduces the incidence of postoperative delirium.