神经阻滞复合全麻对老年患者髋关节置换术后氧代谢及Aβ1-42/tau、S100β的影响

Effects of nerve block combined with general anesthesia on oxygen metabolism and Abeta-42tau and S100beta in elderly patients after hip replacement

目的探究神经阻滞复合全麻对老年患者髋关节置换术后氧代谢及Aβ1-42/tau、S100β的影响。方法选取2016年5月至2019年5月在复旦大学附属华山医院北院就诊的114例股骨粗隆间骨折患者,采用随机数表法分为观察组和对照组各57例。对照组行常规全麻方案,观察组在全麻基础上予腰丛-坐骨神经阻滞及L1~2椎旁神经阻滞。比较两组患者麻醉前(T0)、手术开始时(T1)、手术后30 min(T2)的血流动力学参数、镇痛评分(VAS评分)及脑氧代谢指标;比较两组患者术前、术后1 d、术后3 d、术后7 d的简易智力状态检查量表(MMSE)评分及血清Aβ1-42/tau、S100β表达水平;比较两组患者围手术期的不良反应发生情况。结果T0时刻,两组患者的血流动力学参数比较差异均无统计学意义(P>0.05);T1、T2时刻,两组患者的血流动力学参数较T0时刻明显下降,且对照组的血流动力学参数下降更多,差异均有统计学意义(P<0.05);T0时刻,两组患者的VAS评分比较差异无统计学意义(P>0.05);T2时刻,两组患者的VAS评分明显上升,且对照组VAS评分较观察组明显上升,差异均有统计学意义(P<0.05);T0时刻,两组患者的脑代谢指标比较差异均无统计学意义(P>0.05);T1、T2时刻,两组患者的Da-jvO2均明显降低,且观察组更低,差异均有统计学意义(P<0.05);T1、T2时刻,两组患者的CERvO2、CjvO2均明显上升,且观察组下降更明显,差异均有统计学意义(P<0.05);术前两组患者的MMSE评分比较差异无统计学意义(P>0.05);术后1 d、3 d,两组患者的MMSE评分较前明显下降,且对照组下降更多,差异均有统计学意义(P<0.05);术后7 d两组患者的MMSE评分分别与术前比较差异均无统计学意义(P>0.05);T0时刻,两组患者的血清Aβ1-42/tau、S100β表达水平比较差异均无统计学意义(P>0.05);T1、T2时刻,两组患者的血清Aβ1-42/tau、S100β表达水平较术前明显上升,且对照组升高更多,差异均有显著统计学意义(P<0.01);治疗期间观察组患者的术中大量出血0例、术后恶心呕吐2例、术后疼痛10例,对照组分别为8例、5例、12例,观察组患者术后不良反应发生率为21.05%,明显低于对照组的43.86%,差异有统计学意义(P<0.05)。结论神经阻滞复合全麻能稳定老年患者术中血流动力学指标,改善脑代谢情况,提高术后认知功能,减少POCD发生率,且能降低术后血清Aβ1-42/tau、S100β表达水平。

Objective To explore the effects of nerve block combined with general anesthesia on oxygen metabolism and Abeta-42tau(Aβ1-42/tau)and S100beta(S100β)in elderly patients after hip replacement.Methods A total of 114 patients of intertrochanteric fracture of femur from May 2016 to May 2019 were selected and divided into observation group and control group,with 57 patients in each group.The control group underwent routine general anesthesia,and the observation group received lumbar sciatic nerve block and L1~2 paravertebral nerve block based on general anesthesia.The hemodynamic parameters,VAS scores,indexes of cerebral oxygen metabolism before anesthesia(T0),at the beginning of operation(T1),and at 30 minutes after operation(T2)were compared between the two groups.The MMSE score,Aβ1-42/tau,S100βlevels before operation,1 day after,3 days after and 7 days after operation were compared between the two groups.The incidence of adverse reactions was compared between the two groups.Results At T0,there was no statistically significant difference in the hemodynamic parameters between the two groups(P>0.05);at T1 and T2,the hemodynamic parameters in the two groups decreased significantly compared to those at T0,and the decrease in the control group was more significant(P<0.05).At T0,there was no significant difference in the VAS scores between the two groups of patients(P>0.05);at T2,the VAS scores of the two groups increased significantly,and the VAS score of the control group were significantly higher than those in the observation group(P<0.05).At T0,there was no statistically significant difference in the brain metabolic indexes between the two groups(P>0.05);at T1 and T2,Da-jvO2 in both groups decreased significantly,and the Da-jvO2 in the observation group was significantly lower than that in the control group(P<0.05);at T1 and T2,the CERvO2 and CjvO2 of the two groups increased significantly,and the levels in the observation group decreased more significantly(P<0.05).There was no significant difference in MMSE score between the two groups before operation;on the 1st and 3rd day after operation,the MMSE score of the two groups decreased significantly compared with those before treatment,and the scores in the control group decreased more significantly(P<0.05);on the 7rd day after operation,MMSE scores showed no statistically significant difference with those before treatment(P>0.05).At time T0,there was no significant difference in the expression levels of serumAβ1-42/tau and S100βbetween the two groups(P>0.05);at T1 and T2,the expression levels of serum Aβ1-42/tau and S100βin the two groups increased significantly compared with those before surgery,and the levels in the control group increased more significantly(P<0.05).During the treatment period,there were 0 case of massive bleeding during operation,2 cases of postoperative nausea and vomiting,and 10 cases of postoperative pain in the observation group,versus 8 cases,5 cases,and 12 cases in the control group.The incidence of adverse reactions in the observation group was 21.05%,significantly lower than 43.86%in the control group(P<0.05).Conclusion Nerve block combined with general anesthesia can stabilize hemodynamic parameters,improve brain metabolism,improve cognitive function,reduce the incidence of POCD,and reduce the expression level of serum Aβ1-42/tau and S100βin elderly patients.