超声引导下外周神经阻滞麻醉对老年单膝关节置换术患者血流动力学和认知功能的影响

Effect of Utrasound-guided Peripheral Nerve Block Anesthesia on the Hemodynamics and Cognitive Function of Elderly Patients Undergoing Single Knee Arthroplasty

目的:探究超声引导下外周神经阻滞麻醉对老年单膝关节置换术患者血流动力学和认知功能的影响。方法:选取2017年3月-2019年3月在我院进行单膝关节置换术的老年患者82例,根据麻醉方式不同分为研究组和对照组,每组各41例。研究组采用超声引导下外周神经阻滞麻醉,对照组采用全身麻醉,对比两组的麻醉诱导时间、麻醉维持时间、手术时间等指标,两组入室麻醉前(T0)、气管插管时(T1)、切皮(T2)、止血带60 min(T3)、松止血带5 min(T4)、拔除气管导管时(T5)、术后6 h(T6)、术后24 h(T7)的收缩压(Systolic blood pressure,SBP)、舒张压(Diastolic blood pressure,DBP)、心率(Heart rate,HR)等指标,两组术前、术后6 h、术后12 h、术后24 h的认知功能评分及术后镇痛药物的使用量。结果:研究组的麻醉诱导时间明显长于对照组(P<0.05);两组的麻醉维持时间、手术时间比较均无明显差异(P>0.05);研究组T1、T3、T5时点HR显著低于对照组(P<0.05),T2、T3时点SBP、DBP水平明显高于对照组,T3、T4、T5、T6时点SBP、DBP水平显著低于对照组(P<0.05)。两组术前、术后24 h的认知功能评分对比均无统计学差异(P>0.05);但研究组术后6 h、术后12 h的认知功能评分均明显高于对照组(P<0.05),术后24 h、术后48 h、术后72 h的镇痛药物使用量均明显低于对照组(P<0.05)。结论:在老年单膝关节置换术中,超声引导下外周神经阻滞麻醉对患者血流动力学和认知功能的影响较小,且术后镇痛药物使用量更少。

Objective: To investigate the effects of ultrasound-guided peripheral nerve block anesthesia on hemodynamics and cognitive function in elderly patients undergoing single knee arthroplasty. Methods: Eighty-two elderly patients underwent single knee arthroplasty in our hospital from March 2017 to March 2019 were selected. According to the different anesthesia methods, and divided into the study group and the control group, with 41 patients in each group. The study group used ultrasound-guided peripheral nerve block anesthesia, and the control group used general anesthesia. The two groups were compared for anesthesia induction time, anesthesia maintenance time, operation time and other indicators, before the two groups were anesthetized(T0), tracheal intubation(T1), cut(T2),tourniquet 60 min(T3), loose hemostatic systolic blood pressure(SBP), diastolic blood pressure(DBP) with 5 min(T4), tracheal tube removal(T5), 6 h(T6), 24 h(T7), heart rate(HR) and other indicators. Cognitive function scores and the amount of postoperative analgesics before surgery, at 6 h, 12 h, and 24 h after surgery. Results: The anesthesia induction time of the study group was significantly longer than that of the control group(P<0.05). There was no significant difference in anesthesia maintenance time and operation time between the two groups(P>0.05). The HR of the study group at the T1, T3, and T5 was significantly lower than that of the control group(P<0.05). The levels of SBP and DBP in the study group were higher than those in the control group at T2 and T3, and the levels of SBP and DBP in T3, T4, T5 and T6 were lower than those in the control group(P<0.05). There was no significant difference in the cognitive function scores between the two groups before and after 24 hours(P>0.05). However, the cognitive function scores of the study group were significantly higher than those of the control group at 6 h and 12 h after the operation(P<0.05). The analgesic drug use of the study group was significantly lower than that of the control group at 24 h, 48 h and 72 h after operation(P<0.05). Conclusion: In the elderly single knee arthroplasty, ultrasound-guided peripheral nerve block anesthesia has little impact on the patients’ hemodynamics and cognitive function with less postoperative analgesics.