不同入路髂筋膜间隙阻滞对全髋关节置换术后患者的认知功能、髋关节功能恢复及血清细胞因子的影响

Effects of different approaches of iliofascial space block on cognitive function,hip joint function recovery,and serum cytokines in patients after total hip replacement

目的 分析超声引导下外侧入路、或超声引导下内侧入路骼筋膜间隙阻滞对全髋关节置换术后患者认知功能、髋关节功能恢复及血清细胞因子的影响。方法 选取进行全髋关节置换术的患者140例均分为对照组和观察组,在超声引导下对照组采用传统外侧入路法、观察组采用内侧入路法骼筋膜间隙阻滞麻醉,比较两组一般资料、神经阻滞情况、术后认知情况评分、髋关节评分表(Harris)评分、血清细胞因子水平[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、血清疼痛介质神经肽Y(NPY)、前列腺素E2(PGE2)]。结果 观察组的导管重新固定率、置管时间、术后48 h罗哌卡因用量均较对照组低,置管深度较对照组高,差异具有统计学意义(P <0.05);两组患者术后12 h及24 h的认知功能评分均低于术后1 h,其中观察组的术后12 h、术后24 h的认知评分高于对照组,差异具有统计学意义(P <0.05);观察组患者术后Harris评分较同时点对照组高,差异具有统计学意义(P <0.05);两组患者术后12 h及24 h的血清CRP、TNF-α、NPY、PGE2水平均高于术后即刻,观察组上述指标均低于同时点对照组,差异有统计学意义(P <0.05)。结论 超声引导下内侧入路骼筋膜间隙阻滞麻醉全髋关节置换术的优势明显,有效减少导管重新固定率和术后48 h罗哌卡因用量,缩短置管时间,同时还能够减轻术后认知功能损伤,促进髋关节功能恢复。

Objective To analyze the effects of ultrasound guided iliofascial space block via lateral approach or ultrasound guided medial approach on cognitive function,hip joint function recovery and serum cytokines of patients after total hip replacement.Method A total of 140 patients with total hip replacement were divided into the control group and the observation group.Under the guidance of ultrasound,iliofascial space block anesthesia was implemented for the control group with the traditional lateral approach and the observation group with the medial approach.The general information,nerve block,postoperative awareness scores,and Harris scores,serum cytokine level[C-reactive protein(CRP),tumor necrosis factor-α(tumor necrosis factor-α,TNF-α),serum pain mediator neuropeptide Y(NPY),and prostaglandin E2(PGE2)]of the two groups were all compared.Results The catheter refixation rate,catheterization time,and ropivacaine dosage in 48 h after operation in the observation group were lower than those in the control group,and the catheterization depth was higher than that in the control group,and the differences were statistically significant(P<0.05).The cognitive scores 12 h and 24 h after operation in the two groups were lower than those 1 h after operation,and the cognitive scores 12 h and 24 h after operation in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The postoperative Harris score of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).The levels of serum CRP,TNF-α,NPY,and PGE2 in the two groups 12 h and 24 h after operation were higher than those immediately after operation,and the above indexes in the observation group were lower than those in the control group at the same point,and the differences were statistically significant(P<0.05).Conclusion Ultrasound-guided medial iliofascial space block anesthesia has obvious advantages in total hip arthroplasty,which can effectively reduce the rate of catheter refixation,the dosage of ropivacaine 48 h after operation,shorten the catheterization time,and reduce postoperative cognitive impairment,and promote the recovery of hip function.