舍曲林对腰丛-坐骨神经联合阻滞的老年患者心理状态及术后认知功能的影响

The effect of sertraline hydrochloride on the mental state and postoperative cognitive function in elderly patients with combined lumbar plexus-sciatic nerve block

目的分析老年髋部骨折手术行腰丛-坐骨神经联合阻滞麻醉患者应用盐酸舍曲林干预后,患者认知功能及心理状态的变化。方法应用掷币法,将本院88例老年行髋关节置换术治疗患者分为两组,所有患者手术时均给予腰丛-坐骨神经联合阻滞麻醉,对照组患者44例在术前14d给予心理干预,观察组患者44例术前14d给予盐酸舍曲林口服,对比两组患者手术时间、术中出血量、髋关节功能改变、心理状态、认知功能、血流动力学水平及术后谵妄发生率。结果两组患者手术时间、术中出血量、手术前后Harris、MMSE评分及麻醉前后SpO2、MAP、HR水平均无明显差异(P>0.05);两组患者术后6月Harris评分均高于术前(P<0.05);观察组术后72h SAS、SDS评分低于对照组(P<0.05)。结论腰丛-坐骨神经联合阻滞麻醉对机体认知功能、血流动力学指标水平影响小,能够有效降低术后谵妄发生率,联合舍曲林能够进一步缓解老年髋关节置换术患者围术期不良心理状态。

Objective To analyze the changes in the cognitive function and psychological status of elderly patients undergoing combined lumbar plexus-sciatic nerve block anesthesia for hip fractures after intervention with sertraline hydrochloride.Methods Eighty-eight elderly patients undergoing hip replacement surgery in our hospital were divided into two groups using coin toss.All patients were given a combined lumbar plexus-sciatic nerve block anesthesia during surgery.44 patients in the control group received psychological intervention 14 days before surgery,44 patients in the observation group were given sertraline hydrochloride orally 14 days before the operation.The operation time,intraoperative blood loss,changes in hip joint function,mental status,cognitive function,hemodynamic level and postoperative delirium were compared between the two groups.rate.Results The operation time,intraoperative blood loss,Harris scores before and after operation,MMSE scores,and SpO2,MAP,HR levels before and after anesthesia were not statistically significant in the two groups(P>0.05).Harris scores were higher in both groups at 6 months after operation Before operation(P<0.05).72 h postoperative SAS and SDS scores of the observation group were lower than those of the control group(P<0.05).Conclusion The combined lumbar plexus-sciatic nerve block anesthesia has little effect on the body’s cognitive function and hemodynamic index level,and can effectively reduce the incidence of postoperative delirium.Combined with sertraline hydrochloride can further improve their mental state during the perioperative period in elderly hip replacement patients.