神经阻滞联合喉罩全身麻醉对老年全髋关节置换术后谵妄的影响

Effect of nerve block combined with laryngeal mask general anesthesia on postoperative delirium after total hip arthroplasty in the elderly

目的探讨神经阻滞联合喉罩全身麻醉对老年全髋关节置换术(THA)后谵妄(POD)的影响。方法选取2019年1月至2020年10月于本院接受THA治疗的60例老年股骨颈骨折患者作为研究对象,按随机数字表法分为两组,各30例。对照组采用常规气管插管全身麻醉,观察组采用超声引导下腰丛神经+骶丛神经阻滞联合喉罩全身麻醉,比较两组麻醉效果、术后指标(苏醒时间、定向力恢复时间、拔管时间)、术后72 h内POD发生情况、谵妄评定量表(DRS-R)评分、简易精神状况检查量表(MMSE)评分。结果两组麻醉优良率比较差异无统计学意义。观察组苏醒时间、定向力恢复时间、拔管时间均短于对照组,差异有统计学意义(P<0.05)。术后72 h,观察组POD发生率、DRS-R评分均低于对照组,差异有统计学意义(P<0.05)。术后12、24 h,观察组MMSE评分高于对照组,差异有统计学意义(P<0.05)。结论对老年THA患者进行神经阻滞联合喉罩全身麻醉效果显著,可减少术后POD的发生并减轻其严重程度,促进患者认知功能恢复,且患者术后意识恢复更快。

Objective To investigate the effect of nerve block combined with laryngeal mask general anesthesia on postoperative delirium(POD)after total hip arthroplasty(THA)in the elderly.Methods A total of 60 elderly patients with femoral neck fracture treated with THA in our hospital from January 2019 to October 2020 were selected as the research subjects,and they were divided into two groups according to random table method,with 30 cases in each group.The control group was given general anesthesia with conventional tracheal intubation,and the observation group was given ultrasound guided lumbar plexus nerve plus sacral plexus block combined with laryngeal mask general anesthesia,the anesthesia effect,postoperative indexes(recovery time,recovery time of directional force,extubation time),the occurrence of POD within 72 h after operation,the score of delirium rating scale(DRS-R)and the score of mini-mental state examination scale(MMSE)12 and 24 h before and after operation were compared between the two groups.Results There was no significant difference in the excellent and good rate of anesthesia between the two groups.The recovery time,recovery time of directional force and extubation time of the observation group were shorter than those of the control group,the difference was statistically significant(P<0.05).At 72 h after operation,the incidence of POD and DRS-R score in the observation group were lower than those of the control group,the difference was statistically significant(P<0.05).At 12 and 24 h after operation,the MMSE score of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion The effect of nerve block combined with general anesthesia of laryngeal mask in elderly THA patients has a significant effect,which can reduce the occurrence and severity of POD,promote the recovery of cognitive function,and the recovery of consciousness is faster after operation.