Effect of the ultrasound-guided lumbar plexus and sacral plexus nerve block combined with general anesthesia on the postoperative delirium in elderly patients treated with hip replacement surgery
Effect of the ultrasound-guided lumbar plexus and sacral plexus nerve block combined with general anesthesia on the postoperative delirium in elderly patients treated with hip replacement surgery
徐孟婷 1张景俊 2刘倩影 2陆松虹 2徐晖2
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作者信息
1. 蚌埠医科大学,安徽 蚌埠233030;嘉兴大学附属医院 麻醉科,浙江 嘉兴314000
2. 安徽省蚌埠市第三人民医院 麻醉科,233003
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摘要
目的:探讨超声引导下腰骶丛神经阻滞联合全麻对行髋关节置换术老年病人术后谵妄(POD)的影响.方法:选取髋关节置换术老年病人80例,随机分为腰骶丛神经阻滞联合全麻组(h组)和全麻组(q组),各40例.2组病人均采用喉罩通气,维持脑电双频指数40～60,术后静脉自控镇痛(PCA).比较2组病人术中麻醉药物用量、手术相关指标;采用视觉模拟量表(VAS)评估病人术后疼痛情况;于术前(D0)、术后第1(D1)、3(D3)、7(D7)天分别测定病人意识模糊评估量表(CAM)评分,并抽取静脉血检测白细胞介素(IL)-1β、IL-6、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)和S100β蛋白水平.结果:与q组相比,h组病人术中麻醉药物用量、术后拔管时间、术后24 h PCA次数、术后各时间点VAS评分、首次下床时间及出院时间均明显减少(P<0.01);h组术后IL-1β、IL-6、TNF-α、CRP、S100β蛋白水平、CAM评分及POD发生率均明显低于q组(P<0.01).结论:超声引导下腰骶丛神经阻滞联合全麻较单纯全麻,可减少行髋关节置换术的老年病人麻醉药用量,完善镇痛,降低炎性反应和POD发生率,有助于病人术后快速康复.
Abstract
Objective:To investigate the effects of ultrasound-guided lumbar plexus and sacral plexus nerve block combined with general anesthesia on postoperative delirium( POD) in elderly patients treated with hip replacement surgery. Methods:Eighty elderly patients treated with unilateral hip replacement were randomly divided to the lumbar plexus and sacral plexus nerve block combined with general anesthesia group (group h) and general anesthesia group(group q)(40 cases in each group). The laryngeal mask airway (LMA),maintaining the bispectral index(BIS) for 40-60 and postoperative intravenous controlled analgesia(PCIA) were performed in two groups. The amount of anesthetic drugs and related indexes of operation were compared between two groups. The visual analogue scale(VAS) was used to evaluate the postoperative pain. The CAM scores in two groups before operation (D0),on the day 1(D1),day 3(D3) and day 7(D7) were measured. The serum levels of interleukin(IL-1β),IL-6,tumor necrosis factor α(TNF-α),C-reactive protein ( CRP ) and S100β protein were determined. Results:Compared with the group q,the intraoperative anesthetic dosage,postoperative extubation time,PCA frequency after 24 h of surgery,VAS score at each postoperative time point,first time out of bed and discharge time were significantly reduced in group h(P<0. 01). After operation,the levels of IL-1β,IL-6,TNF-α,CRP,S100βprotein,CAM score and incidence rate of POD in group h were lower than those in group q (P<0. 01). Conclusions:The ultrasound-guided lumbar plexus and sacral plexus nerve block combined with general anesthesia can reduce the dosage of anesthetics,degree of pain,inflammatory response and incidence rate of POD,and promote the postoperative rapid recovery in elderly patients treated with hip replacement surgery.
关键词
腰骶丛神经阻滞/全身麻醉/术后谵妄/髋关节置换术
Key words
lumbar plexus and sacral plexus nerve block/general anesthesia/postoperative delirium/hip replacement/surgery
维普
万方数据