超声引导下腰丛-坐骨神经阻滞复合丙泊酚对老年股骨粗隆间骨折手术患者血清NGF-β、MBP水平和术后认知功能的影响

Effects of ultrasound-guided lumbar plexus-sciatic nerve block combined with propofol on serum NGF-βand MBP levels and postoperative cognitive function in elderly patients with femoral intertrochanteric fracture surgery

目的探究超声引导下腰丛-坐骨神经阻滞复合丙泊酚对老年股骨粗隆间骨折(FIF)手术患者血清神经生长因子-β(NGF-β)、髓鞘碱性蛋白(MBP)水平和术后认知功能的影响。方法选择2017年1月至2019年6月本院收治的85例老年FIF患者作为研究对象,采用随机抛掷硬币法分为对照组(n=41,全麻+瑞芬太尼麻醉维持)和研究组(n=44,腰丛-坐骨神经阻滞联合全麻+瑞芬太尼联合丙泊酚麻醉维持)。比较两组的感觉、运动阻滞的起效和维持时间、NGF-β、MBP水平及认知功能。结果研究组感觉、运动阻滞的起效时间明显短于对照组,维持时间明显长于对照组(P<0.05)。术后1 d,两组的血清NGF-β水平、MMSE评分均较术前降低,MBP水平均升高(P<0.05);术后3 d,两组的血清NGF-β水平、MMSE评分均较术后1 d升高,MBP水平均降低(P<0.05);术后1、3 d,研究组的血清NGF-β水平、MMSE评分明显高于对照组,MBP水平明显低于对照组(P<0.05);研究组的POCD发生率明显低于对照组(P<0.05)。结论超声引导下腰丛-坐骨神经阻滞复合丙泊酚可明显提高老年FIF手术患者的NGF-β水平,抑制MBP释放,降低麻醉对早期认知功能的影响。

ABSTRACT: Objective To explore the effects of ultrasound-guided lumbar plexus-sciatic nerve block combined with propofol on serum nerve growth factor-β (NGF-β) and myelin basic protein (MBP) levels and postoperative cognitive function in elderly patients with femoral intertrochanteric fracture (FIF) surgery. Methods A total of 85 elderly patients with FIF admitted in our hospital from January 2017 to June 2019 were selected as the research subjects, and the patients were divided into control group (n=41, general anesthesia + remifentanil anesthesia maintenance ) and research group (n=44, lumbar plexus-sciatic nerve block combined with general anesthesia + remifentanil combined with propofol for anesthesia maintenance) by random coin toss method. The onset and maintenance time of sensory and motor block, NGF-β and MBP levels, cognitive function were compared between the two groups. Results The onset time of sensory and motor block in the research group were significantly shorter than those in the control group, and the maintenance time were significantly longer than those in the control group (P<0.05). One day after operation, the serum NGF-β level and MMSE score of the two groups were lower than those before operation, and the MBP level increased (P<0.05);3 d after operation, the serum NGF-β level and MMSE score of the two groups were higher than those on the 1 d after operation, and the MBP level decreased (P<0.05);at 1 d and 3 d after operation, the serum NGF-β level and MMSE score in the research group were significantly higher than those in the control group, and the MBP level was significantly lower than that in the control group (P<0.05);the incidence of POCD in the research group was significantly lower than that in the control group (P<0.05). Conclusion Ultrasound-guided lumbar plexus-sciatic nerve block combined with propofol can significantly increase the level of NGF-β in elderly patients undergoing FIF surgery, inhibit the release of MBP, and reduce the effect of anesthesia on early cognitive function.