摘要
目的 分析髋关节囊周围神经阻滞联合喉罩全麻对髋关节置换患者脑源性神经营养因子(BDNF)/酪氨酸激酶B(TrkB)信号通路的影响.方法 前瞻性选取2022年11月至2023年11月河北省沧州中西医结合医院收治的86例择期进行髋关节置换的患者为研究对象,随机抽签法将其分为观察组和对照组,每组各43例.观察组给予髋关节囊周围神经阻滞联合喉罩全麻,对照组给予髂筋膜间隙阻滞联合喉罩全麻.比较两组各项手术指标、不同时间点[麻醉前(T0)、置入喉罩时(T1)、置入假体时(T2)及手术结束(T3)]生命体征指标、术后镇痛泵按压次数及舒芬太尼用量、手术前后BDNF、TrkB水平以及疼痛视觉模拟评分法(VAS)、简易智力状态检查量表(MMSE).结果 观察组苏醒时间、拔管时间及恢复室停留时间均短于对照组,差异均有统计学意义(P＜0.05);两组术中补液量及麻醉时间比较,差异均无统计学意义(P＞0.05).与T0比较,两组T2～T3时的心率、MAP明显升高,但观察组T2～T3时的心率、MAP均低于对照组,差异均有统计学意义(P＜0.05).术后48 h内观察组镇痛泵按压总次数、镇痛泵按压有效次数及舒芬太尼用量分别为(5.13±1.37)次、(4.01±1.27)次、(69.45±5.83)μg,均少于对照组[(8.94±2.63)次、(7.85±2.33)次、(80.33±7.31)µg],差异均有统计学意义(P＜0.05).术后1 d,两组BDNF、TrkB均较术前明显升高,观察组BDNF、TrkB 分别为(170.33±28.56)、(8.33±1.45)μg/L,均高于对照组[(150.41±25.37)、(6.74±0.85)μg/L],差异均有统计学意义(P＜0.05).术后1 d,两组VAS、MMSE评分均较术前明显下降,观察组VAS评分为(2.06±0.35)分,低于对照组[(3.13±0.37)分],MMSE评分为(27.33±1.26)分,高于对照组[(25.34±1.21)分],差异均有统计学意义(P＜0.05).结论 髋关节囊周围神经阻滞联合喉罩全麻对髋关节置换患者的镇静效果显著,可有效维持生命体征稳定,减轻疼痛程度,激活BDNF/TrkB信号通路,减轻手术麻醉对患者认知功能的影响.
Abstract
Objective To analyze the effects of hip capsular nerve block combined with laryngeal mask general anesthesia on brain-de-rived neurotrophic factor(BDNF)/tyrosine kinase B(TrkB)signaling pathway in patients with hip replacement.Methods A total of 86 patients undergoing elective hip replacement admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province from November 2022 to November 2023 were selected as the study objects,and were divided into the observation group(peripheral hip capsule nerve block combined with laryngeal mask general anesthesia)and the control group(iliofascial space block combined with laryngeal mask general anes-thesia)according to the random drawing method,with 43 cases in each group.The surgical index,vital signs index at different time points[before anesthesia(T0),at the time of laryngeal mask insertion(T1),at the time of prosthesis insertion(T2)and at the end of operation(T3)],post-operative analgesic pump compression times,sufentanil dosage,BDNF,TrkB levels visual analogue(VAS)score and Mini-Mental State Exami-nation(MMSE)score before and after operation of the two groups were compared.Results The recovery time,extubation time and recovery room residence time in the observation group were shorter than those in the control group,the differences were statistically significant(P＜0.05);there were no statistically significant differences in intraoperative fluid volume and anesthesia time between the two groups(P＞0.05).Compared with T0,the heart rate and MAP at T2-T3 in the two groups were significantly increased,but the heart rate and MAP at T2-T3 in the observation group were lower than those in the control group,the differences were statistically significant(P＜0.05).Within 48 hours after surgery,the total num-ber of analgesic pump pressing,the effective number of analgesic pump pressing and the dosage of sufentanil in the observation group were(5.13±1.37)times,(4.01±1.27)times and(69.45±5.83)µg,respectively,which were less than those in the control group[(8.94±2.63)times,(7.85±2.33)times,(80.33±7.31)μg],the differences were statistically significant(P＜0.05).One day after operation,the levels of BDNF and TrkB in the two groups were significantly higher than those before operation,the levels of BDNF and TrkB in the observation group were(170.33±28.56)and(8.33±1.45)μg/L,respectively,which were higher than those in the control group[(150.41±25.37)and(6.74±0.85)μg/L],and the differences were statistically significant(P＜0.05).One day after operation,the VAS and MMSE scores of the two groups were significantly lower than those before operation,the VAS score of the observation group was(2.06±0.35)points,which was lower than that of the control group[(3.13±0.37)points],the MMSE score was(27.33±1.26)points,which was higher than that of the control group[(25.34±1.21)points],and the differences were statistically significant(P＜0.05).Conclusion Hip capsular nerve block combined with laryngeal mask general anesthesia has a significant sedative effect on hip replacement patients,which can effectively maintain the stability of vital signs,reduce the degree of pain,activate BDNF/TrkB signaling pathway,and reduce the impact of surgical anesthesia on the cognitive func-tion of patients.
维普
万方数据