超声联合神经刺激仪定位腰丛——骶丛神经阻滞对高龄股骨头置换术患者血流动力学、心理状态及认知功能的影响

Effect of Lumbosacral Plexus Block Nerve Block by Ultrasound Combined with Nerve Stimulator on Hemodynamics, Mental State and Cognitive Function in Elderly Patients Undergoing Femoral Head Replacement

目的:探讨超声联合神经刺激仪定位腰丛——骶丛神经阻滞对高龄股骨头置换术患者血流动力学、心理状态及认知功能的影响。方法:选取2017年4月~2020年3月期间我院收治的行股骨头置换术的高龄患者98例,采用随机数字表法分为对照组和研究组,各49例,对照组给予神经刺激仪定位腰丛--骶丛神经阻滞,研究组在此基础上联合超声引导,比较两组血流动力学、心理状态、认知功能、临床指标及不良反应。结果:两组T1~T4时间点收缩压(SBP)、心率(HR)、舒张压(DBP)组间及组内比较均未见明显差异(P>0.05)。研究组阻滞起效时间、阻滞持续时间、术后镇痛持续时间长于对照组,阻滞完成时间、术后下床活动时间短于对照组(P<0.05)。两组术后1d回忆能力、瞬时记忆力、注意力和计算力、定向力、语言能力评分均下降,但研究组高于对照组(P<0.05),研究组的术后认知功能障碍(POCD)发生率低于对照组(P<0.05)。两组术后1 d焦虑自评量表(SAS)和抑郁自评量表(SDS)评分均下降,且研究组低于对照组(P<0.05)。两组不良反应发生率比较无差异(P>0.05)。结论:超声联合神经刺激仪定位腰丛-骶丛神经阻滞对高龄股骨头置换术患者阻滞效果确切,对其血流动力学影响轻微,可减轻其认知功能损害,改善其负性情绪。

Objective: To investigate the effect of lumbosacral plexus block nerve block with ultrasound combined with nerve stimulator on hemodynamics, mental state and cognitive function in elderly patients with femoral head replacement. Methods: 98 elderly patients with femoral head replacement in our hospital from April 2017 to March 2020 were selected, and divided into control group and study group by random number table method, with 49 cases in each group. The control group was given nerve stimulator to locate lumbosacral plexus block nerve block, and the study group was combined with ultrasound guidance, the hemodynamics, mental state, cognitive function, clinical indicators and adverse reactions of the two groups were compared. Results: Systolic blood pressure(SBP), heart rate(HR) and diastolic blood pressure(DBP) at T1-T4 between the two groups and within the group were not significantly different(P>0.05). The onset time of block, duration time of block and postoperative analgesia duration time of the study group were longer than those of the control group, while the completion time of the block and the postoperative ambulation time of the study group were shorter than those of the control group(P<0.05). The scores of recall ability, instant memory, attention and calculation ability, orientation and language ability of the two groups decreased 1 d after operation, but the scores of the study group were higher than those of the control group(P<0.05), and the incidence rate of cognitive dysfunction(POCD) of the study group was lower than that of the control group(P<0.05).The self rating anxiety scale(SAS) and self rating depression Scale(SDS) of the two groups decreased 1 d after operation, and the study group was lower than the control group(P<0.05). There was no difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Ultrasound combined with nerve stimulator localization of lumbosacral plexus block nerve block in elderly patients with femoral head replacement has exact block effect, slight impact on hemodynamics, can reduce cognitive function damage and improve their negative emotions.