右美托咪定复合超声引导下髂筋膜联合腰骶丛神经阻滞对全髋关节置换术患者应激反应及认知功能的影响

Effects of dexmedetomidine and ultrasound guided iliac fascia combined with lumbosacral plexus block on stress response and cognitive function in patients undergoing total hip arthroplasty

目的探讨右美托咪定复合超声引导下髂筋膜联合腰骶丛神经阻滞在全髋关节置换术中的应用效果。方法选取我院收治的200例全髋关节置换术患者作为研究对象,根据麻醉方式不同将其分为对照组(100例,超声引导下髂筋膜联合腰骶丛神经阻滞)和观察组(100例,右美托咪定复合超声引导下髂筋膜联合腰骶丛神经阻滞)。比较两组的应激反应指标[皮质醇(Cor)、去甲肾上腺素(NE)]、认知功能指标[神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S100-β)]及苏醒质量。结果手术30 min(T_(1))、术毕(T_(2))时,观察组的Cor、NE、NSE、S100-β水平均低于对照组(P<0.05)。两组的呼之睁眼时间、呼之握拳时间、苏醒时间及拔管时间比较,差异均无统计学意义(P>0.05)。结论临床对全髋关节置换术患者采用右美托咪定复合超声引导下髂筋膜联合腰骶丛神经阻滞有助于减轻机体应激反应,降低对认知功能的影响,也不会影响患者的术后苏醒质量。

Objective To investigate the application effect of dexmedetomidine and ultrasound guided iliac fascia combined with lumbosacral plexus block in total hip arthroplasty.Methods A total of 200 patients with total hip arthroplasty admitted in our hospital were selected as the research objects.According to different anesthesia methods,the patients were divided into control group(100 cases,ultrasound guided iliac fascia combined with lumbosacral plexus block)and observation group(100 cases,dexmedetomidine and ultrasound guided iliac fascia combined with lumbosacral plexus block).The stress response indexes[cortisol(Cor),norepinephrine(NE)],cognitive function indexes[neuron specific enolase(NSE),central nerve specific protein(S100-β)]and recovery quality were compared between the two groups.Results At 30 min after operation(T_(1))and the end of operation(T_(2)),the levels of Cor,NE,NSE and S100-βin the observation group were lower than those in the control group(P<0.05).There were no significant differences in eye opening time upon calling,clenching time upon calling,awakening time and extubation time between the two groups(P>0.05).Conclusion The clinical use of dexmedetomidine and ultrasound guided iliac fascia combined with lumbosacral plexus block in patients undergoing total hip arthroplasty is helpful to reduce the body's stress response,reduce the impact on cognitive function,and will not affect the postoperative recovery quality of patients.