术前镇痛对老年人股骨颈骨折行髋关节置换术后早期认知功能障碍的影响

Effect of perioperative analgesia on early cognitive dysfunction after hip replacement in femoral neck fracture in the elderly

目的:探讨术前镇痛对老年人股骨颈骨折行髋关节置换术后早期认知功能障碍(POCD)的影响。方法:选择2017年3月至2018年6月本院骨科收治的60例拟行髋关节置换术的老年股骨颈骨折患者为研究对象,随机将其分为A组和B组。A组(30例)术前采用连续髂筋膜阻滞镇痛,B组(30例)采用术后连续髂筋膜阻滞镇痛。应用简易智能精神量表(MMSE)、视觉模拟评分(VAS)评估两组患者围术期认知功能和疼痛程度,并对比两组患者POCD的发生情况。结果:两组手术时间、罗哌卡因用量、术中出血量对比差异均无统计学意义[分别为(113.5±0.7) min vs(120.8±0.9) min、(72.1±13.5)μg vs(71.5±12.5)μg、(136.5±21.7) ml vs(140.2±22.5) ml,均P>0.05]。A组MMSE评分在T1-T4高于B组(P<0.05),VAS在T0-T4低于B组(P<0.05)。A组术后72 h POCD发生率为10.00%,B组为26.67%,差异具有统计学意义(P<0.05)。A组术后并发症发生率为6.67%,B组为10.00%,差异无统计学意义(P>0.05)。结论:术前采用连续髂筋膜阻滞镇痛可显著降低患者术后疼痛程度和POCD的发生,且不增加麻醉用药的剂量和术后并发症风险。

Objective: To investigate the effect of perioperative analgesia on early cognitive impairment(POCD in elderly patients with femoral neck fracture after hip replacement.Methods: Sixty patients with femoral neck fractures undergoing hip arthroplasty admitted to our department from March 2017 to June 2018 were randomly divided into two groups,30 in each.A group(30 cases) used continuous iliac fascia block analgesia before operation,B group(30 cases) used continuous iliac fascia block analgesia after operation.Using simple intelligence mental scale(MMSE),visual analogue scale(VAS) perioperative awareness of the two groups of patients was assessed.The degree of function and pain,and the incidence of POCD in the two groups were compared.Results: There was no significant difference in the operation time,ropivacaine dosage,intraoperative blood loss between the two groups [(113.5±0.7) min vs(120.8±0.9) min,(72.1±13.5) μg vs(71.5±12.5) μg,(136.5±21.7) ml vs(140.2±22.5) ml,P>0.05].The MMSE scores of group A were higher in T1-T4 than in group B(P<0.05),and the VAS scores were lower in T0-T4 than in group B(P<0.05).The incidence of POCD was 10.00% in group A and 27.67% in group B.The difference between the two groups was statistically significant(P<0.05).The postoperative complication rate was 6.67% in group A and 10.00% in group B.There was no significant difference between the two groups(P>0.05).Conclusion: Perioperative use of continuous fascia block analgesia can significantly reduce postoperative pain and the occurrence POCD,and does not increase the dose of anesthetic medication and the risk of postoperative complications.