领结征髂筋膜阻滞的髋关节置换术中舒芬太尼不同剂量预测模型的效果

Effects of different dose prediction models of sufentanil during hip arthroplasty with bow tie fascia iliac block

目的比较行超声引导下领结征髂筋膜阻滞的老年髋关节置换术中舒芬太尼不同剂量预测模型的效果。方法选择2018年6月至2022年6月于本院行超声引导下领结征髂筋膜阻滞的老年髋关节置换术患者90例为研究对象。采用一元线性回归方程模型(ALR)、多元线性回归方程模型(MLR)或人工神经网络模型(DBN)确定舒芬太尼剂量,患者按单盲法随机分为ALR组、MLR组和DBN组,每组30例。比较各组患者镇痛效果、血流动力学指标、炎症因子水平、手术指标。采用Kaplan-Meier法分析各组患者术后2周髋部感染发生情况。结果各组患者性别、年龄、体质量、美国麻醉医师协会分级和合并症情况比较差异均无统计学意义(P>0.05)。DBN组患者术后24 h的Harris评分、感觉阻滞持续时间高/长于ALR组,术后24 h疼痛数字评分量表(NRS)、手术开始时和手术开始后30 min的平均动脉压(MAP)及心率(HR)、术后24 h白细胞介素-17(IL-17)和肿瘤坏死因子α(TNF-α)水平、感觉阻滞起效时间、患者自控镇痛(PCA)按压次数低/早/少于ALR组,术后24 h的改良警觉/镇静评分(OAA/S)显著低于ALR组和MLR组,差异均有统计学意义(P<0.05)。MLR组患者术后24 h的Harris评分、感觉阻滞持续时间高/长于ALR组,术后12 h的改良OAA/S评分、手术开始后30 min的MAP、术后24 h IL-17和TNF-α水平、感觉阻滞起效时间、PCA按压次数低/长/少于ALR组,差异均有统计学意义(P<0.05)。Kaplan-Meier分析结果显示,各组患者术后2周髋部感染发生率比较差异有统计学意义(P<0.05);ALR组和DBN组患者术后2周髋部感染发生率比较差异有统计学意义(P<0.05)。结论在领结征髂筋膜阻滞老年髋关节置换术中使用MLR和DBN计算舒芬太尼剂量的有效性优于ALR,且DBN优势更明显。

Objective To compare the effects of different dose prediction models of sufentanil in elderly hip arthroplasty with ultrasound-guided bow tie fascia iliac block.Methods A total of 90 elderly patients who underwent ultrasound-guided bow tie fascia iliac during hip arthroplasty in our hospital from June 2018 to June 2022 were selected.The dose of sufentanil was determined by a linear regression(ALR),multiple linear regression(MLR)or deep belief networks(DBN).Patients were randomly divided into the ALR group,the MLR group and the DBN group,with 30 cases in each group.The analgesic effect,hemodynamic index,inflammatory factor level and surgical index were compared among all groups.Kaplan-Meier method was used to analyze the incidence of hip infection 2 weeks after surgery in each group.Results There was no significant difference in the gender,age,body weight,American Society of Anesthesiologists(ASA)classification or complications among all groups(P>0.05).The Harris score 24 hours after surgery and duration of sensory block in the DBN group were higher/longer than those in the ALR group,numerical rating scale(NRS)score 24 hours after surgery,mean arterial pressure(MAP)and heart rate(HR)at the beginning of surgery and 30 minutes after surgery,levels of interleukin-17(IL-17)and tumor necrosis factor-α(TNF-α)24 hours after surgery,onset time of sensory block,and number of patient controlled analgesia(PCA)compression were lower/earlier/less than those in the ALR group,the modified observer's assessment of alertness/sedation scale(OAA/S)score 24 hours after surgery was significantly lower than those in the ALR group and the MLR group,with statistically significant differences(P<0.05).Harris score 24 hours after surgery and duration of sensory block in the MLR group were higher/longer than those in the ALR group,modified OAA/S score 12 hours after surgery,MAP 30 minutes after surgery,levels of IL-17 and TNF-α24 hours after surgery,onset time of sensory block,and the number of PCA compressions were lower/longer/less than those in the ALR group,with statistically significant differences(P<0.05).Kaplan-Meier analysis showed that there were significant differences in the incidences of hip infection 2 weeks after surgery among all groups(P<0.05),and there were significant differences in the incidences of hip infection 2 weeks after surgery between the ALR group and the DBN group(P<0.05).Conclusion The effectiveness of calculating the dose of sufentanil using the MLR and DBN in elderly hip arthroplasty with bow tie fascia iliac block is better than that of ALR,and the advantage of DBN is more obvious.