不同麻醉方式对老年股骨颈骨折患者认知功能及IL-2及其sIL-2R水平的影响

Effect of different anesthesia modes on cognitive function,IL-2 and sIL-2R levels in elderly patients with femoral neck fracture

目的探讨全身麻醉联合硬膜外麻醉对老年股骨颈骨折患者认知功能、全身炎性反应的影响。方法选择2016年3月至2017年3月该院行股骨颈骨折根治术的患者70例,按照随机数字表法分为观察组和对照组,各35例。观察组采用全身麻醉联合硬膜外麻醉,对照组采用静吸复合全身麻醉,对比两组患者术后认知功能、疼痛指标及炎性反应程度的情况。结果两组术前机械痛阈值比较,差异无统计学意义(P>0.05),两组患者术后6、12、24、48 h机械痛阈值均较术前降低,且观察组术后各时间点机械痛阈值均较对照组升高,差异均有统计学意义(P<0.05)。观察组术后1、4、7 d简易智力状态检查量表(MMSE)评分分别为(22.5±2.9)、(24.6±2.3)、(27.7±2.3)分,明显高于对照组患者,差异有统计学意义(P<0.05)。两组患者治疗前白细胞介素-2(IL-2)及可溶性白细胞介素-2受体(sIL-2R)水平比较,差异无统计学意义(P>0.05),治疗后观察组患者IL-2及sIL-2R水平均明显低于对照组,差异均有统计学意义(P<0.05)。结论全身麻醉联合硬膜外麻醉有利于改善老年股骨颈骨折患者认知功能及血清IL-2及sIL-2R水平。

Objective To investigate the effect of general anesthesia combined with epidural anesthesia on the cognitive function and systemic inflammatory response in elderly patients with femoral neck fracture. Methods Seventy cases of femoral neck fracture radical operation in this hospital from March 2016 to March 2017 were selected and divided into the observation group and control group according to the random number table method,35 cases in each group. Theobservation group adopted general anesthesia combined with epidural anesthesia,while the control group adopted intravenous-inhalation combined general anesthesia. Then the postoperative cognitive function,pain index and inflammatory reaction degree were compared between the two groups. Results The preoperative mechanical pain threshold had no statistically significant difference between the two groups,the mechanical pain threshold at postoperative 6,12,24,48 h in two groups was decreased compared with before operation（P〈0.05）,moreover the mechanical pain threshold value at each time point in the observation group was increased compared with the control group,the difference was statistically significant（P〈0.05）. The MMSE scores on postoperative 1,4,7 d in the observation group were（22.5±2.9）,（24.6±2.3）and（27.7±2.3）points respectively,which were significantly higher than those in the control group,the differences were statistically significant（P〈0.05）. The levels of IL-2 and sIL-2 R level before treatment had no statistically significant difference between the two groups（P〉0.05）,but which after treatment in the observation group were significantly lower than those in the control group,the differences were statistically significant（P〈0.05）. Conclusion General anesthesia combined with epidural anesthesia can be conducive to improve the cognitive function and serum IL-2 and sIL-2 R levels in elderly patients with femoral neck fracture.