全麻复合股神经阻滞在老年糖尿病患者膝关节置换术中的应用价值

Application Value of General Anesthesia Combined with Femoral Nerve Block in Elderly Diabetic Patients with Knee Arthroplasty

目的:探究全麻复合股神经阻滞在老年糖尿病患者膝关节置换术中的应用价值。方法:选择2020年6月-2021年10月福建医科大学附属泉州第一医院行膝关节置换术治疗的老年糖尿病患者98例为观察对象,按麻醉方案不同将其分成对照组(n=49)与观察组(n=49)。对照组采用全麻,观察组采用全麻复合股神经阻滞麻醉。对比两组术后疼痛程度、炎症因子水平、空腹血糖水平及不良反应发生率。结果:观察组术后2、4、8、24 h疼痛视觉模拟评分量表(VAS)评分较对照组均低,差异均有统计学意义(P<0.05);术后24 h,两组血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平较术前均升高,但观察组均低于对照组,差异均有统计学意义(P<0.05);术后1 h,两组空腹血糖水平较麻醉前均升高,但观察组低于对照组(P<0.05);观察组术后不良反应发生率为8.16%(4/49),低于对照组的24.49%(12/49),差异有统计学意义(P<0.05)。结论:全麻复合股神经阻滞麻醉能增强老年糖尿病患者膝关节置换术的镇痛效果,改善机体炎症反应及围手术期糖代谢,且不良反应少,值得提倡。

Objective:To explore the application value of general anesthesia combined with femoral nerve block in elderly diabetic patients with knee arthroplasty.Method:A total of 98 elderly diabetic patients who underwent knee arthroplasty in Quanzhou First Hospital Affiliated to Fujian Medical University from June 2020 to October 2021 were selected as the observation objects,and they were divided into the control group (n=49) and the observation group (n=49) according to different anesthesia protocols.The control group was anesthetized by general anesthesia,and the observation group was anesthetized by general anesthesia combined with femoral nerve block.The degree of postoperative pain,inflammatory factors levels,fasting blood glucose levels and incidence of adverse reactions between two groups were compared.Result:The visual analogue scale (VAS) scores of the observation group at 2,4,8 and 24 h after operation were lower than those in the control group,and the differences were statistically significant (P<0.05).At 24 h after operation,the serum C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) levels of two groups were increased compared with those before operation,but the observation group were lower than those of the control group,and the differences were statistically significant (P<0.05).At 1 h after operation,the fasting blood glucose levels of two groups compared with those before anesthesia were increased,but the increase degree of the observation group was lower than that of the control group (P<0.05).The incidence of postoperative adverse reactions in the observation group 8.16% (4/49) was lower than 24.49% (12/49) in the control group,and the difference was statistically significant (P<0.05).Conclusion:General anesthesia combined with femoral nerve block can enhance the analgesic effect of knee arthroplasty in elderly diabetic patients,improve the inflammatory reaction and perioperative glucose metabolism,and less adverse reactions,which is worthy of promoting.