神经阻滞联合全麻对老年人工股骨头置换术患者术后镇痛和认知功能的影响

摘要 目的：探讨髂筋膜间隙阻滞（FICB）联合全麻对老年人工股骨头置换术（FHR）患者围术期镇痛和术后认知功能的影响。方法：将行FHR术的老年患者104例作为研究对象。随机分为分为对照组与试验组，每组52例。对照组采用单纯全麻，试验组实施FICB联合全麻。于术后4 h、12 h、24 h和48 h，记录患者视觉模拟（VAS）评分；记录两组镇痛情况；分别于术前、术后1 d、术后3 d、术后7 d使用简易精神状态量表（MMSE）对患者进行认知功能评定；记录两组镇痛不良反应和住院时间；分别于术前1 d和术后1 d，对患者进行血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的检测。结果：在术后4 h~24 h，试验组相比对照组有着更低的VAS评分（P<0.05）；两组术后48 h VAS评分无统计学差异（P>0.05）。相比对照组，试验组术中使用的瑞芬太尼更少（P<0.05），术后使用舒芬太尼也较少（P<0.05）。术后1 d和术后3 d，试验组相比对照组有着较高MMSE评分（P<0.05）；术后7 d内，试验组POCD发生率低于对照组（9.62% vs 25.00%，P<0.05）。较于对照组，试验组有着较低的恶心呕吐发生率及较短的术后住院时间（P<0.05）。术后1 d，相比对照组，试验组有着较低的IL-6、TNF-α水平（P<0.05）。结论：FICB复合全麻可为老年FHR患者提供更好的镇痛效果，使阿片类药物消耗减少，并可降低术后炎症水平，有助于改善术后认知功能。

Effect of Nerve Block Combined with General Anesthesia on Postoperative Analgesia and Cognitive Function in Elderly Patients undergoing Artificial Femoral Head Replacement

ABSTRACT Objective: To investigate the effects of fascia iliaca compartment block (FICB) combined with general anesthesia on perioperative analgesia and postoperative cognitive function in elderly patients undergoing artificial femoral head replacement (FHR). Methods: 104 elderly patients undergoing FHR were selected and were randomly divided into control group and experimental group, each group has 52 cases. The two groups was treated with simple general anesthesia, FICB combined with general anesthesia respectively. Visual analogue scale (VAS) scores were recorded at 4 h, 12 h, 24 h and 48 h after operation. Record the analgesia of the two groups; before operation and 1 d, 3 d and 7 d after operation, the mini-mental state examination (MMSE) was used to evaluate the patients''s cognitive function. The analgesic adverse reactions and hospitalization time of the two groups were recorded. The serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected 1 day before operation and 1 day after operation. Results: At 4 h ~ 24 h after surgery, the experimental group had a lower VAS score than the control group(P<0.05). The dosage of remifentanil in the experimental group decreased comparing with the control group(P<0.05), and the dosage of sufentanil decreased within 48 hours after operation (P<0.05). Compared with the control group at 1 day after operation and 3 days after operation, the MMSE score of the experimental group was higher(P<0.05). Within 7 days after operation, compared with the control group, the incidence of POCD in the experimental group was lower(9.62 % vs 25.00 %, P<0.05). Compared with the control group, the incidence of postoperative nausea and vomiting in the experimental group decreased significantly (P<0.05), and the postoperative hospital stay was shortened (P<0.05). At 1 day after operation, compared with the control group, the experimental group had lower levels of IL-6 and TNF-α(P<0.05). Conclusion: FICB combined with general anesthesia can provide better analgesic effect for elderly patients with FHR, reduce opioid consumption, reduce inflammatory levels, and improve postoperative cognitive function.