小剂量丙泊酚联合腰丛坐骨神经阻滞对老年FIF患者的影响

Effects of low-dose propofol combined with lumbar sciatic plexus nerve block in elderly patients with FIF

目的:探讨小剂量丙泊酚(P)联合腰丛坐骨神经阻滞(L-SPNB)对老年股骨粗隆间骨折(FIF)患者血流动力学的影响。方法:选取123例老年FIF患者,按照随机数字表法将其分为两组。A组61例给予全身麻醉,B组62例给予L-SPNB联合小剂量P麻醉,比较两组的阻滞效果、血流动力学、应激反应情况、认知功能。结果:T1时,两组警觉/镇静(OAA/S)评分比较,无统计学差异(P>0.05);T2时,B组的OAA/S评分低于A组,差异具有统计学意义(P<0.05);T1、T2时,B组的心率(HR)、平均动脉压(MAP)均低于A组(P<0.05);T1、T2时,B组的血清去甲肾上腺素(NE)、皮质醇(Cor)水平均低于A组(P<0.05);术后1 d、术后3 d,B组的蒙特利尔认知评估量表(MoCA)、简易精神状态量表(MMSE)评分均高于A组(P<0.05)。结论:小剂量P联合L-SPNB与静脉全身麻醉的阻滞效果确切,且对FIF患者术中的血流动力学影响更小。

Objective:To investigate the effect of low-dose propofol(P)combined with lumbar sciatic plexus nerve block(L-SPNB)on the hemodynamics in elderly patients with femoral intertrochanteric fracture(FIF).Methods:123 elderly patients with FIF were selected and randomly divided into two groups.61 patients in group A received general anesthesia,while group B received the anesthesia of L-SPNB combined with P.The blocking effect,hemodynamics,stress response condition and cognitive function of the two groups were compared.Results:There were no significant differences in OAA/S scores of both groups at T1(P>0.05);OAA/S scores of group B were lower than those of group A at T2,with a statistically significant difference(P<0.05).The heart rate(HR)and mean arterial pressure(MAP)in group B were lower than that in group A at T1 and T2(P<0.05).The serum noradrenaline(NE)and cortisol(Cor)in group B were lower than those in group A(P<0.05)at T1 and T2.One day and three days after operation,the Montreal Cognitive Assessment(MoCA)and the Mini-mental State Examination(MMSE)in group B were all higher than those in group A(P<0.05).Conclusion:The block effect of low-dose P combined with L-SPNB is confirmed by significantly effects of intravenous general anesthesia,and it has less effect on hemodynamics during operation of patients with FIF.