连续髂筋膜间隙阻滞对老年髋部骨折患者炎症反应及术后谵妄的影响

Effects of continuous fascia iliaca compartment block on inflammatory response and postoperative delirium in elderly patients with hip fracture

目的观察老年髋部骨折患者术前予以连续髂筋膜间隙阻滞(CFICB)镇痛在降低术后谵妄(POD)发生率方面是否发挥作用,并通过检测相关炎症细胞因子来探索炎症反应与POD之间的关系。方法选取2021年1~12月南华大学附属第二医院老年髋部骨折患者80例,年龄65~85岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为神经阻滞组(A组,n=40)和常规镇痛组(B组,n=40)。A组在入院后由麻醉科医生在超声引导下行CFICB,B组按照临床规定及患者需求常规予以布洛芬镇痛,2次/d。两组患者行腰硬联合麻醉后再进行手术,手术结束后均行自控硬膜外镇痛并保留48 h。分别评估并记录2组患者在入院时(T_(1))、镇痛后30 min(T_(2))、麻醉摆放体位时(T_(3))、术毕(T_(4))及术后72 h(T_(5))的运动及静息时NRS评分及围术期补救镇痛情况;观察并记录2组患者术前镇痛相关不良反应发生情况。另外还需记录患者术前等待时间及住院时间。在T_(1)、T_(3)、T_(4)、T_(5)时抽取2组患者的静脉血,测量血清IL-6、IL-10浓度。通过简易智力状态检查量表及意识紊乱测试法分别评估患者术前的基础认知功能及术后当天、术后1 d、3 d的发生情况。结果在T_(2)、T_(3)时,B组患者在静息及运动状态下的NRS评分均高于A组(P<0.05)。与B组相比,A组患者术前镇痛补救次数明显减少(P<0.05),且B组的术前镇痛相关不良反应发生率高于A组(P<0.05)。在T_(3)、T_(4)时,IL-6水平A组低于B组,在T_(3)时的IL-10水平A组高于B组(P<0.05)。A组的发生率低于B组(P<0.05)。结论与常规镇痛药物相比,术前予以CFICB更能有效缓解老年髋部骨折患者的术前疼痛,降低了POD的发生率其可能与抑制围术期炎症反应相关。

Objective To observe whether preoperative continuous fascia iliaca compartment block(CFICB)for preoperative analgesia can reduce the incidence of postoperative delirium(POD)in elderly patients with hip fracture,and to explore the relationship between inflammatory response and POD by detecting the levels of related inflammatory cytokines.Methods A total of 80 elderly hip fracture patients aged 65-85 years with ASA Ⅱ or Ⅲ in the Second Affiliated Hospital of Nanhua University were selected and divided into nerve block group(group A,n=40)and conventional analgesia group(group B,n=40)by random number table method.Group A received CFICB,group B received ibuprofen static drops(2 times/d)according to clinical requirements and patient needs.The two groups of patients received combined spinal-epidural anesthesia before surgery,and patient-controlled epidural analgesia was given for 48 h after the operation.The NRS score and the number of perioperative rescue analgesics taken from the two groups of patients were evaluated and recorded at admission(T_(1)),30 min after analgesia(T_(2)),during positioning before anesthesia(T_(3)),after surgery(T_(4)),and 72 h after surgery(T_(5))at rest and during exercise.The occurrence of preoperative analgesia-related adverse reactions in the two groups was observed and recorded.Meanwhile,the patient’s preoperative waiting time and the length of hospital stay were recorded.At T_(1),T_(3),T_(4),and T_(5),the venous blood of the two groups of patients was drawn,and the serum IL-6 and IL-10 concentrations were measured.The basic cognitive function of the patients before surgery was assessed by the Simple Mental State Examination Scale;the occurrence of delirium on the day after surgery,1 d,and 3 d after surgery was assessed by the Consciousness Disorder Test.Results At T_(2) and T_(3),the NRS scores of patients in group B at rest and during exercise were higher than those in group A(P<0.05).Compared with group B,perioperative rescue analgesics taken in group A was significantly reduced(P<0.05),and the incidence of preoperative analgesia-related adverse reactions in group B was higher than that in group A(P<0.05).At T_(3) and T_(4),the level of IL-6 in group A was lower than that in group B,and the level of IL-10 in group A at T_(3) was higher than that in group B(P<0.05).The incidence of delirium in group A was lower than that in group B(P<0.05).Conclusion Compared with conventional analgesics,preoperative CFICB can effectively relieve preoperative pain in elderly patients with hip fracture,and reduce the incidence of postoperative delirium,which may be related to the inhibition of perioperative inflammatory response.