腹股沟上髂筋膜阻滞复合全身麻醉对高龄髋关节置换术患者术中体征和术后谵妄影响

Effect of inguinal iliac fascia block combined with general anesthesia onsigns and postoperative delirium in elderly patients with hip replacement

目的探讨腹股沟上髂筋膜阻滞复合全身麻醉对高龄髋关节置换术患者体征波动与术后谵妄的影响。方法选取2020年3月—2022年12月期间接受髋关节置换术的126例高龄患者作为研究对象,采用随机数字表法分为对照组和观察组,各63例。对照组采用常规全身麻醉,观察组采用腹股沟上髂筋膜阻滞复合全身麻醉。对比两组入室时(T_(0))、静脉泵注10 min时(T_(1))及术中30 min(T_(2))的生命体征指标[心率(HR)、平均动脉压(MAP)],手术前后C反应蛋白(CRP),术后意识状态[谵妄评定方法(CAM-CR)]、谵妄发生情况及不良反应。结果观察组T_(1)的HR、MAP高于对照组,T_(2)的HR、MAP低于对照组(P<0.05)。观察组术后CRP指标低于对照组(P<0.05)。观察组CAM-CR评分低于对照组,谵妄发生率低于对照组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论采用腹股沟上髂筋膜阻滞复合全身麻醉可有效预防高龄髋关节置换术患者术后谵妄。

Objective To evaluate the effect of inguinal iliac fascia block combined with general anesthesia on sign fluctuations and postoperative delirium in elderly patients undergoing hip arthroplasty.Methods The study was conducted among 126 elderly patients who underwent hip replacement surgery from March 2020 to December 2022.They were randomly divided into a control group and an observation group using random number table method,with 63 patients in each group.The control group received routine general anesthesia,while the observation group received inguinal iliac fascia block combined with general anesthesia.Vital sign indicators[heart rate(HR),mean arterial pressure(MAP)]at entry(T_(0)),intravenous infusion(T_(1)),and intraoperative 30 min(T_(2)),preoperative and postoperative C-reactive protein(CRP),postoperative consciousness status[confusion assessment method(CAMCR)],delirium occurrence,and adverse reactions were compared between the two groups.Results The HR and MAP at T_(1) in the observation group were higher than those in the control group,while the HR and MAP at T_(2) were lower(P<0.05).The postoperative CRP in the observation group was lower than that in the control group(P<0.05).The CAMCR score and the incidence rate of delirium of the observation group were lower than those of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The use of inguinal iliac fascia block combined with general anesthesia can effectively prevent postoperative delirium in elderly patients undergoing hip arthroplasty.