超声引导下星状神经节阻滞对老年患者术后认知功能的影响

Effect of ultrasound-guided stellate ganglion block on postoperative cognitive function in elderly patients

目的探究超声引导下星状神经节阻滞(SGB)对老年髋部骨折(HF)患者术后认知功能的影响。方法选取2022年4月至2023年12月江西省新余市人民医院收治的70例老年髋部骨折患者为研究对象,采用随机数字表分为两组,即对照组(n=35)、实验组(n=35),对照组实施常规麻醉方案,基于此,实验组实施超声引导下SGB;于入室前(T0)、手术30 min(T1)、术毕前10 min(T2)比较两组血流动力学[平均动脉压(MAP)、心率(HR)]、脑氧代谢指标[脑血流量/脑氧耗比(CBF/CMRO_(2))、脑氧摄取率(CEO_(2))];于术前、术后1 d、3 d时比较两组认知功能[简易精神状况检查表(MMSE)]。结果T1、T2时,两组HR、MAP均较T0时下降,但实验组T1时[HR、MAP分别为(82.50±6.36)次/min、(89.25±8.07)mmHg(1 mmHg=0.133 kPa)]、T2时[HR、MAP分别为(83.06±6.33)次/min、(90.11±8.09)mmHg]均高于对照组T1时[HR、MAP分别为(75.25±8.02)次/min、(82.25±8.37)mmHg]、T2时[HR、MAP分别为(77.54±7.04)次/min、(85.05±8.12)mmHg]数值,差异有统计学意义(P<0.05);T1、T2时,两组CBF/CMRO_(2)均较T0时下降,但实验组[(16.33±2.09)、(16.30±2.05)]高于对照组[(14.53±2.11)、(14.24±2.09)];两组CEO_(2)均较T0时升高,但实验组[(34.49±3.50)、(31.05±4.06)]低于对照组[(39.59±3.36)、(35.91±5.06)],差异均有统计学意义(P<0.05)。实验组术后1 d、3 d的MMSE评分[(24.02±1.08)分、(24.89±1.15)分]高于对照组[(22.10±1.12)分、(22.54±1.07)分],差异有统计学意义(P<0.05)。结论超声引导下SGB可稳定老年患者血流动力学,改善脑氧代谢,降低术后认知功能障碍风险。

Objective To investigate the effect of ultrasound-guided stellate ganglion block(SGB)on postoperative cognitive function in elderly patients with hip fractures(HF).Methods A total of 70 elderly HF patients admitted to Xinyu People's Hospital from April 2022 to December 2023 were selected as the study subjects.They were randomly assigned into the control group(n=35)and the experimental group(n=35).Patients in both groups received routine anesthesia,and those in the experiment were additionally treated with ultrasound-guided SGB.Hemodynamics(mean arterial pressure[MAP],heart rate[HR]),and cerebral oxygen metabolism indicators(cerebral blood flow to cerebral metabolic rate of oxygen ratio[CBF/CMRO_(2)],and cerebral extraction of oxygen[CEO_(2)])before entering the operation room(T0),30 minutes after surgery(T1),and 10 minutes before the end of the surgery(T2)were compared.Cognitive function between two groups before surgery and 1 and 3 days after surgery was assessed using the Mini Mental State Examination(MMSE).Results HR and MAP at T1 and T2 both significantly decreased than those at T0.HR(T1:[82.50±6.36]times/min VS[75.25±8.02]times/min;T2:[83.06±6.33]times/min VS[77.54±7.04]times/min)and MAP(T1:[89.25±8.07]mmHg VS[82.25±8.37]mmHg,1 mmHg=0.133 kPa;T2:[90.11±8.09]mmHg VS[85.05±8.12]mmHg)at T1 and T2 were significantly higher in the experimental group than those of control group(P<0.05).CBF/CMRO_(2) at T1 and T2 in both groups significantly decreased compared with that at T0.It was significantly higher in the experimental group than the control group at T1([16.33±2.09]VS[14.53±2.11])and T2([16.30±2.05]VS[14.24±2.09]),P<0.05.CEO_(2) at T1 and T2 in both groups significantly increased compared with that at T0.It was significantly lower in the experimental group than the control group at T1([34.49±3.50]VS[39.59±3.36])and T2([31.05±4.06]VS[35.91±5.06]),P<0.05.The MMSE scores at postoperative day 1([24.02±1.08]points VS[22.10±1.12]points)and day 3([24.89±1.15]points VS[22.54±1.07]points)were significantly higher in the experimental group than those of control group(P<0.05).Conclusion Ultrasound-guided SGB can stabilize hemodynamics,improve cerebral oxygen metabolism,and reduce the risk of postoperative cognitive dysfunction in elderly patients.