右美托咪定腰丛-坐骨神经阻滞麻醉对患者股骨粗隆间骨折围手术期炎症反应及术后认知功能障碍的影响

Effects of dexmedetomidine lumbar plexussciatic nerve block anesthesia on perioperative inflammatory response and postoperative cognitive dysfunction in patients with intertrochanteric fracture of femur

目的探讨右美托咪定腰丛-坐骨神经阻滞麻醉对患者股骨粗隆间骨折围手术期炎症反应及术后认知功能障碍的影响。方法选取2020年1月至2021年1月黔东南苗族侗族自治州人民医院收治的102例股骨粗隆间骨折患者作为研究对象,根据随机数字表法分为对照组与观察组,各51例。对照组围手术期给予咪达唑仑腰丛-坐骨神经阻滞麻醉,观察组围手术期给予右美托咪定腰丛-坐骨神经阻滞麻醉,比较两组麻醉前、诱导后5 min、维持药物停药时刻和术后1 h血清炎症因子[肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)]水平、自主呼吸恢复时间和清醒时间及术前1 d、术后12 h、术后1 d和术后3 d认知功能评分(MMSE)与术后不良事件发生情况和认知功能障碍(POCD)发生率。结果两组TNF-α、IL-6、IL-1β水平组间、时间、交互比较差异有统计学意义(P<0.05)。麻醉前,两组TNF-α、IL-6、IL-1β水平比较差异无统计学意义;诱导后5 min、维持药物停药时刻、术后1 h,观察组TNF-α、IL-6、IL-1β水平均明显低于对照组,差异有统计学意义(P<0.05)。观察组自主呼吸恢复时间、清醒时间均明显短于对照组,差异有统计学意义(P<0.05)。两组MMSE评分组间、交互比较,差异有统计学意义(P<0.05)。两组MMSE评分时间比较差异无统计学意义。术前1 d,两组MMSE评分比较差异无统计学意义;术后12 h、术后1 d、术后3 d观察组MMSE评分均明显高于对照组,差异有统计学意义(P<0.05)。观察组不良事件发生率为5.88%、POCD发生率为13.37%,明显低于对照组的19.61%、31.37%,差异有统计学意义(P<0.05)。结论股骨粗隆间骨折患者围手术期采取右美托咪定腰丛-坐骨神经阻滞麻醉有利于减轻围手术期炎症反应,促进患者认知功能恢复,能增强镇静效果,且提高苏醒质量,安全性较高,具有临床推广应用价值。

Objective To investigate the effect of dexmedetomidine lumbar plexus-sciatic nerve block anesthesia on perioperative inflammation and postoperative cognitive dysfunction in patients with intertrochanteric fractures.Methods A total of 102 patients with intertrochanteric fracture admitted to Qiandongnan Miao and Dong Autonomous Prefecture People's Hospital from January 2020 to January 2021 were selected as the research subjects,and they were divided into control group and observation group according to random number table method,with 51 cases in each group.The control group was given midazolam lumbar plexus-sciatic nerve block anesthesia perioperatively,and the observation group was given dexmedetomidine lumbar plexus-sciatic nerve block anesthesia during the perioperative period,and serum inflammatory factors[tumor necrosis factor(TNF-α),interleukin-6(IL-6),interleukin-1β(IL-1β)],spontaneous breathing recovery time and wakefulness time,1 d before anesthesia,12 h after surgery,and 1 d after surgery and 3 d postoperative cognitive function score(MMSE)were associated with postoperative adverse events and incidence of cognitive impairment(POCD)were compared between the two groups.Results There were significant differences of the levels of TNF-α,IL-6 and IL-1βbetween the two groups of inter-group,time and interaction(P<0.05).Before anesthesia,there was no significant difference in TNF-α,IL-6 and IL-1βlevels between the two groups;at 5 minutes after induction,the maintenance time of drug withdrawal,and 1 h after surgery,the levels of TNF-α,IL-6 and IL-1βin the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The spontaneous breathing recovery time and awake time in the observation group were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).The difference between the two groups and interactive of the two groups was statistically significant(P<0.05).There was no significant difference in the time of MMSE scores between the two groups.At 1 d before surgery,there was no significant difference in MMSE scores between the two groups;12 h,1 d after surgery and 3 d after surgery,the MMSE scores in the observation group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).The incidence of adverse events in the observation group was 5.88%and the incidence of POCD was 13.37%,which were significantly lower than 19.61%and 31.37%in the control group,and the difference was statistically significant(P<0.05).Conclusion Esmedetomidine lumbar plexus-sciatic nerve block anesthesia in patients with intertrochanteric fracture of the femur is beneficial to reduce perioperative inflammation,promote the recovery of cognitive function,enhance the sedation effect,improve the quality of awakening,have high safety,and have clinical application value.