腰丛-坐骨神经阻滞对股骨粗隆间骨折患者血清S100β、BDNF的影响

Effects of lumbar plexus sciatic nerve block on serum S100βand BDNF in patients with femur intertrochanteric fracture

目的探讨腰丛-坐骨神经阻滞对股骨粗隆间骨折患者血清S100β、脑源性神经营养因子(BDNF)的影响。方法选取2016年5月至2018年5月就诊的114例股骨粗隆间骨折患者,随机分观察组和对照组,每组57例。2组采用相同静脉全麻方案,观察组在全麻基础上予腰丛-坐骨神经阻滞。比较2组患者麻醉前(T0),手术开始时(T1),手术30 min时(T2),手术后30 min(T3)不同时刻血流动力学参数及镇静评分(OAA/S评分),分析围手术期2组患者不良反应发生情况;比较2组患者麻醉前后血清S100β、BDNF表达情况。结果T0时刻2组患者血流动力学参数及OAA/S评分差异无统计学意义(P>0.05);T1、T2、T3时刻2组血流动力学参数、OAA/S评分T0时刻明显下降,且T1、T2、T3时刻观察组血流动力学参数较对照组明显上升,观察组OAA/S评分较对照组明显上升(P<0.05);观察组围手术期不良反应发生率明显低于对照组(P<0.05);麻醉前2组患者血清S100β、BDNF表达水平差异无统计学意义(P>0.05),麻醉后2组患者S100β表达水平较前明显升高,且观察组S100β表达水平较对照组明显下降(P<0.05),麻醉后2组患者BDNF表达水平较麻醉前均明显下降,且观察组BDNF表达水平较对照组明显上升(P<0.05)。结论腰丛-坐骨神经阻滞能使股骨粗隆间骨折患者麻醉效果更好,围术期更安全,能降低术后S100β表达水平,升高术后BDNF表达水平,改善术后不良反应情况。

Objective To investigate the effects of lumbar plexus sciatic nerve block on serum S100βand brain-derived neurotrophic factor(BDNF)in patients with femur intertrochanteric fracture.Methods A total of 114 patients with femur intertrochanteric fracture who were admitted and treated in our hospital from May 2016 to May 2018 were divided into observation group(n=57)and control group(n=57).The patients in both groups were treated by intravenous general anesthesia scheme,on that basis,the patients in observation group were treated by lumbar plexus sciatic nerve block.The hemodynamic parameters and alertness/sedation score(OAA/S)before anesthesia(T0),at the beginning of operation(T1),30 min after the beginning of operation(T2),at 30 minutes after operation(T3)were observed and compared between the two groups.Moreover the incidence of adverse reactions at perioperative period,and the expression levels of serum S100βand BDNF before and after anesthesia were observed and compared between the two groups.Results There were no significant differences in the hemodynamic parameters and OAA/S scores at T0 between the two groups(P>0.05).The hemodynamic parameters,and OAA/S score at T1,T2 and T3 in both groups were significantly decreased,as compared with those at T0,moreover,which at T1,T2 and T3 in observation group were significantly higher than those in contral group(P<0.05).The incidence rate of adverse reaction at perioperative period in observation group was significantly lower than that in contral group(P<0.05).Before anesthesia there were no significant differences in the serum levels of S100βand BDNF between the two groups(P>0.05).After anesthesia,the serum levels of S100βin both groups were significantly higher than those before anesthesia,and the serum levels of S100βin observation group were significantly lower than those in control group(P<0.05).After anesthesia,the serum levels of BDNF in both groups were significantly lower than those before anesthesia,which in observation group were significantly higher than those in control group(P<0.05).Conclusion The lumbar plexus sciatic nerve block can improve the anesthesia effects at perioperative period in patients with femur intertrochanteric fracture,which can decrease the expression levels of S100β,and increase the expression levels of BDNF,and improve the cognitive function of patients.