老年髋关节置换术患者神经阻滞联合全身麻醉对血流动力学及认知功能的影响

Effects of nerve block combined with general anesthesia on hemodynamics and cognitive function in elderly patients undergoing hip arthroplasty

目的:研究老年髋关节置换术患者应用神经阻滞联合全身麻醉对血流动力学及认知功能的影响。方法:选取2018年3月至2019年4月在辽宁中医药大学附属医院就诊的老年髋关节置换术患者100例,随机分为对照组和观察组各50例。其中对照组采用常规全身麻醉,观察组采用神经阻滞联合全身麻醉,比较观察组与对照组手术中血流动力学变化、手术后视觉模拟评分(VAS)、手术后患者认知功能及手术前后患者血清中心型脂肪酸结合蛋白(H-FABP)、脑型脂肪酸结合蛋白(B-FABP)水平。结果:手术过程中观察组血流动力学指标较对照组稳定(P<0.05)。手术结束后2、6、12、24 h观察组患者VAS评分均较对照组低(P<0.05)。手术结束后第1天和第3天观察组患者认知能力显著优于对照组(P<0.05)。手术结束后6 h,观察组患者血液中H-FABP和B-FABP水平显著低于对照组(P<0.05)。结论:神经阻滞联合全身麻醉在老年髋关节置换术中使用能明显改善手术过程中患者血流动力学波动,减轻患者术后疼痛,降低患者术后认知障碍,缓解患者术后H-FABP及B-FABP水平的升高。

Objective:To study the effect of nerve block combined with general anesthesia on hemodynam⁃ics and cognitive function in elderly patients undergoing hip arthroplasty.Methods::A total of 100 el⁃derly patients undergoing hip arthroplasty in Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from March 2018 to April 2019 were randomly divided into control group(n=50)and observation group(n=50).The routine general anesthesia was used in the control group and nerve block combined with general anesthesia was used in the observation group.The hemodynamic changes,postoperative visual analogue score(VAS),postoperative cognitive function,and the levels of heart fatty acid binding protein(H⁃FABP)and brain fatty acid binding protein(B⁃FABP)in serum before and after operation were compared between the observation group and the control group(P<0.05).Results::During the operation,the hemodynamic index of the observation group was more stable than that of the control group(P<0.05).VAS scores of patients in the observation group were lower than those in the control group at the timepoints of 2 h,6 h,12 h,and 24 h after operation.The cognitive ability of the observation group was significantly better than that of the control group on the 1st and 3rd days after operation(P<0.05).Six hours after operation,the blood levels of H⁃FABP and B⁃FABP in the observation group were significantly lower than those in the control group(P<0.05).Conclusion::Nerve block combined with general anesthesia can significantly im⁃prove the hemodynamic fluctuation,relieve postoperative pain,reduce postoperative cognitive impair⁃ment,and alleviate the increase of postoperative H⁃FABP and B⁃FABP levels in elderly patients un⁃dergoing hip arthroplasty.