目的 探讨收肌管阻滞联合全身麻醉对老年全膝关节置换术(TKA)患者术后疼痛和认知功能的影响.方法 采用随机数字表法将72例需行TKA的老年患者分为对照组和观察组,每组36例.对照组患者采用单纯全身静脉麻醉,观察组在对照组基础上行超声引导下收肌管阻滞,2组患者术后连接静脉自控镇痛泵(PCIA).记录2组患者入室(T0)、置入喉罩(T1)、手术开始30 min(T2)及术毕(T3)心率(HR)、收缩压(SBP)和舒张压(DBP).记录术后48 h内疼痛视觉模拟量表(VAS)评分,术后3 d 白细胞介素(IL)-6、C-反应蛋白(CRP)水平和简易精神状态量表(MMSE)评分.记录2组丙泊酚和舒芬太尼用量、PCIA按压次数、苏醒时间、拔管时间、首次下床时间和住院时间.结果 与对照组比较,观察组在T1、T2时间点HR降低,SBP和DBP升高(P＜0.05);术后静息及活动后VAS评分、CRP和IL-6水平均降低,而MMSE评分升高(P＜0.05);丙泊酚和舒芬太尼用量、PCIA按压次数、术后苏醒、拔管、首次下床及住院时间均降低(P＜0.05).结论 超声引导下收肌管阻滞联合全身麻醉有助于减轻老年全膝关节置换手术患者术后疼痛,缓解应激反应,改善认知水平.
Effects of ultrasound-guided adductor canal block combined with general anesthesia on postoperative pain and cognitive function in elderly patients undergoing total knee arthroplasty
Objective To investigate the impact of adductor canal block combined with general anesthesia on postoperative pain and cognitive function in elderly patients undergoing total knee arthroplasty(TKA).Methods A total of 72 elderly patients undergoing elective TKA were selected and divided into the control group and the observation group with 36 patients in each group using a random number table method.The control group was given simple general intravenous anesthesia,and the observation group received adductor canal block under ultrasound guidance combined with general anesthesia.Both groups of patients were connected to patient-controlled intravenous analgesia(PCIA)pumps after surgery.Data of heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)were recorded at the time of entering the operating room(T0),insertion of the laryngeal mask(T1),30 minutes after the start of surgery(T2)and the end of surgery(T3).Visual analog scale(VAS)pain scores were recorded in the first 48 hours postoperatively.Levels of C-reactive protein(CRP),interleukin-6(IL-6)and Mini-Mental State Examination(MMSE)scores were recorded 3 days after surgery.Additionally,the dosage of propofol and sufentanil,PCIA press times,awakening time,extubation time,first time out of bed and length of hospital stay were compared between the two groups.Results Compared with the control group,the observation group showed a decrease in HR at T1 and T3,and an increase in SBP and DBP(P＜0.05).In comparison with the control group,the observation group showed lower VAS scores,along with reduced CRP and IL-6 levels,and higher MMSE scores(P＜0.05)at the same postoperative time points.Patients in the observation group showed reduced doses of propofol and sufentanil,fewer PCIA presses,shorter postoperative recovery,extubation,first time out of bed and hospital stay than those of patients in the control group(P＜0.05).Conclusion The application of ultrasound-guided adductor canal block combination with general anesthesia helps alleviate postoperative pain,relieve stress responses and improve cognitive function level in elderly patients with total knee replacement surgery.
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