腰硬联合麻醉结合髂筋膜阻滞对老年髋关节手术患者神经阻滞效果及认知功能的影响

Effect of combined spinal-epidural anesthesia and iliac fascia block on nerve block effect and cognitive function in elderly patients with hip joint operation

目的探讨腰硬联合麻醉结合髂筋膜阻滞对老年髋关节手术患者神经阻滞效果及术后认知功能的影响。方法将80例行髋关节手术的老年患者随机分为观察组和对照组,每组40例。对照组行腰硬联合麻醉,观察组在对照组基础上结合髂筋膜阻滞进行干预,并使用冷感消失法判定患者髂筋膜腔隙阻滞效果。记录患者使用芬太尼总量;采用疼痛VAS评分评估患者各时间段疼痛情况;采用MMSE评分评价患者认知功能;酶联免疫吸附法检测患者血浆中IL-6、Sββ100、Aβ1~40水平。结果观察组芬太尼用量显著低于对照组(P<0.05)。侧卧位及术后6h、1d、2d时观察组VAS评分显著低于对照组(P<0.05)。观察组阻滞后20 min及侧卧位时患者神经阻滞效果与阻滞前比较差异有统计学意义(P<0.05)。术后1、2、3d时MMSE评分观察组显著低于对照组(P<0.05)。两组治疗后各时点IL-6较术前均显著升高(P<0.05),且对照组显著高于观察组(P<0.05);术后6h、1d时两组患者Sββ100、Aβ1~40均显著高于术前水平(P<0.05),且观察水平显著低于对照组(P<0.05)。结论腰硬联合麻醉结合髂筋膜阻滞可提高老年髋关节手术患者神经阻滞效果及降低术后认知功能障碍的发生。

Objective To investigate the effect of combined spinal-epidural anesthesia and iliac fasial blDck on the nerve block effect and cognitive function in elderly patients with hip arthroplasty. Methods The 80 cases of patients undergone hip joint surgery were randomly divided into observation group and control group 40 cases io eachgroup. The control group underwent combined spinal-epidural anesthesia, the observation group was given ilia fscia block intervention on the base of the control group, apathetic disappearance method was used to evaluate the fascia iliaca compartment block effect. The total fentanyl dosage was recorded, VAS was used to evaluate the paUents mn situa- tion at every period, mini-mental state examination（MMSE） score was used to evaluate the cognitive functa2 tients, enzyme linked immunosorbent assay method was used to detect the plasma IL-6, Sa1OO,AI3J Jleli Re- suits The fentanyl dosage in the observation group was significantly lower than that in the control 0 05 ）. At lateral position and 6 h, 1 d ,2 d postoperation, the VAS of the observation group were significantly lower than those in the control group （P 〈 O. 05）. In the observation group, there was statistically significant diffence for the pa- tients＇ nerve block effect between 20 min after nerve block, lateral position and before nerve bloclil（ P 〈0, 05 ） ;the MMSE scores of the observation group were significantly lower than those of the control group at 1 .d, 2 d .and 3 d postoperation （P 〈 O. 05）. IL-6 levels of the two groups significantly increased at different time points （P.〈 O. 05 ）, and which of the control group were significantly higher than observation group （ P 〈 0. 05 ）. At postoperative 6 h, 1 d, two groups patients of S 100 A1-40 were significantly higher than those of preoperative levels （P 〈 O. 05） and the observation were significantly lower than the control group （ P 〈 O. 05 ）. Conclusions Combmed spmal-epldural an- esthesia and iliac fascia block can effectively improve the nerve block effect and cognitive function in llderly patients with hip joint operation