不同麻醉方式对老年全髋置换手术患者围术期神经认知紊乱及炎性因子IL-6的影响

Effects of Different Anesthesia Methods on Perioperative Neurocognitive Disorders and Inflammatory Factor IL-6 in Elderly Patients Undergoing Total Hip Replacement

目的 研究不同麻醉方式对老年全髋置换手术患者围术期神经认知紊乱(Perioperative Neurocognitive Disorders,PND)以及炎症因子的影响。方法 选取行全髋置换手术患者72例,根据麻醉方式不同被随机分为全身麻醉组和外周神经阻滞组。分别在术前24h(T0)、术后24h(T1)、术后1周(T2)、术后1个月(T3)、术后3个月(T4)及术后半年(T5)通过MMSE评分测定患者的认知功能,于T0、T1和T2抽取患者静脉血检测血清IL-6因子表达水平。观察两组术后躁动及药物不良反应。结果 与全麻组相比,外周神经阻滞组术后24h(T1)、术后1周(T2)时段IL-6明显降低,同时期MMSE评分则显著增高,其差异具有统计学意义(P<0.05);其中全麻组有4例患者在术后24h(T1)、术后1周(T2)时发生了PND,其中有2例在术后1个月(T3)、3个月(T4)时仍存在PND,而外周神经阻滞组患者无PND的发生。与全麻组相比,外周神经阻滞组患者低血压、术后恶心呕吐、术后躁动及眩晕的发生率明显降低,差异具有统计学意义(P<0.05)。结论 不同麻醉方式对老年全髋置换手术患者术后认知功能及炎症因子的影响不同,外周神经阻滞可以减少围术期神经认知紊乱的发生。

Objective To study the effects of different anesthesia methods on perioperative neurocognitive disorders(PND)and inflammatory factors in elderly patients undergoing total hip replacement.Methods 72 patients with total hip replacement were randomly divided into general anesthesia group and peripheral nerve block group according to different anesthesia methods.The cognitive function of patients was measured by MMSE score 24 hours before operation(T0),24 hours after operation(T1),1 week after operation(T2),1 month after operation(T3),3 months after operation(T4)and half a year after operation(T5).The expression level of serum IL-6 factor was measured by venous blood from patients at T0,T1 and T2.Adverse reactions such as agitation,nausea,vomiting and vertigo were recorded.Results Compared with the general anesthesia group,IL-6 in the peripheral nerve block group decreased significantly at 24 hours(T1)and 1 week(T2)after operation,and MMSE score increased significantly at the same time(P<0.05);Among them,4 patients in the general anesthesia group developed PND at 24 hours(T1)and 1 week(T2)after operation,and 2 patients still had PND at 1 month(T3)and 3 months(T4),while there was no PND in the peripheral nerve block group.The incidence of nausea and vomiting after general anesthesia was significantly lower than that after general anesthesia(P<0.05).Conclusion Different anesthesia methods have different effects on postoperative cognitive function and inflammatory factors in elderly patients undergoing total hip replacement.Peripheral nerve block can reduce the occurrence of perioperative neurocognitive disorder.