全身麻醉结合股神经及坐骨神经阻滞对下肢骨折患者术后苏醒质量、应激反应和认知功能的影响

摘要 目的：观察全身麻醉结合股神经及坐骨神经阻滞对下肢骨折患者术后苏醒质量、应激反应和认知功能的影响。方法：选择2020年7月-2021年7月期间我院收治的103例下肢骨折手术患者，依据双色球随机分组法分为对照组（51例，接受全身麻醉）和观察组（52例，接受全身麻醉结合股神经及坐骨神经阻滞）。观察两组血流动力学、术后苏醒质量、应激反应和认知功能的变化，记录两组围术期不良反应发生情况。结果：两组诱导麻醉后（T2）时间点心率（HR）、平均动脉压（MAP）较麻醉前（T1）时间点下降，观察组置喉罩即刻（T3）~置喉罩后60 min（T5）时间点HR、MAP低于对照组（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。观察组的苏醒时间短于对照组，躁动发生率低于对照组（P<0.05）。两组麻醉苏醒期肾上腺素（E）、皮质醇（Cor）均较麻醉维持期升高，但观察组低于对照组（P<0.05）。观察组视空间与执行、记忆、命名、注意、语言、抽象、定向力、延迟回忆维度评分及总分均高于对照组（P<0.05）。结论：下肢骨折患者采用全身麻醉结合股神经及坐骨神经阻滞，可稳定血流动力学，提高术后苏醒质量，减轻应激反应和对认知功能的影响。

Effects of General Anesthesia Combined with Femoral Nerve and Sciatic Nerve Block on Postoperative Awakening Quality, Stress Response and Cognitive Function in Patients with Lower Limb Fracture

ABSTRACT Objective: To observe the effects of general anesthesia combined with femoral nerve and sciatic nerve block on postoperative awakening quality, stress response and cognitive function in patients with lower limb fractures. Methods: 103 patients with lower limb fractures who were treated in our hospital from July 2020 to July 2021 were aelected, and they were divided into control group (51 cases, general anesthesia) and observation group (52 cases, general anesthesia combined with femoral nerve and sciatic nerve block) according to the double color ball method. The changes of hemodynamics, postoperative awakening quality, stress response and cognitive function in two groups were observed, and the perioperative adverse reactions in two groups were recorded. Results: The heart rate (HR) and mean arterial pressure (MAP) in the two groups after induction anesthesia (T2) time points were lower than those before anesthesia (T1). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). HR and MAP in the observation group were lower than those in the control group from immediately (T3) to 60min (T5) after laryngeal mask(P<0.05). The awakening time in the observation group was shorter than that in the control group, and the incidence of agitation was lower than that in the control group (P<0.05). The adrenaline (E) and cortisol (Cor) in the two groups in the anesthesia awakening period were higher than those in the anesthesia maintenance period, but the observation group was lower than the control group(P<0.05). The scores and total scores of visual space and execution, memory, naming, attention, language, abstraction, directional force and delayed recall in the observation group were higher than those in the control group (P<0.05). Conclusion: General anesthesia combined with femoral nerve and sciatic nerve block for patients with lower limb fracture can stabilize hemodynamics, improve postoperative awakening quality, reduce stress response and influence on cognitive function.