超声引导下腰骶丛神经阻滞联合全身麻醉对老年髋关节置换术患者认知功能、氧化应激和血流动力学的影响

摘要 目的：探讨超声引导下腰骶丛神经阻滞联合全身麻醉对老年髋关节置换术患者认知功能、氧化应激和血流动力学的影响。方法：选取2018年1月~2020年1月期间我院收治的80例行髋关节置换术的老年患者，采用随机数字表法分为对照组（全身麻醉）和研究组（全身麻醉基础上联合超声引导下腰骶丛神经阻滞）各40例。比较两组患者认知功能、氧化应激、血流动力学、疼痛情况及不良反应。结果：两组麻醉前~术毕清醒时心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度 （SpO₂）均呈先下降后升高趋势（P<0.05）；研究组麻醉10 min后SpO₂、MAP、HR高于对照组（P<0.05）。两组术前1 d~术后3 d超氧化物歧化酶（SOD）呈降低后升高趋势，丙二醛（MDA）呈升高后降低趋势（P<0.05）；研究组术后1 d、术后3 d的SOD高于对照组，MDA低于对照组（P<0.05）。两组术前1 d~术后3 d简易智能状态量表（MMSE）评分呈先降低后升高趋势，但研究组术后1 d、术后3 d评分高于对照组（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。研究组术后1 h、术后12 h、术后24 h视觉疼痛模拟评分法（VAS）评分低于对照组（P<0.05）；两组术后48 h VAS评分比较无差异（P>0.05）。结论：老年髋关节置换术中应用超声引导下腰骶丛神经阻滞联合全身麻醉，可有效减轻机体血流波动、氧化应激以及对认知功能的损害，同时还可减轻患者术后早期疼痛，且安全性较好。

Effects of Lumbosacral Plexus Block Combined with General Anesthesia under Ultrasound Guidance on Cognitive Function, Oxidative Stress and Hemodynamics in Elderly Patients Undergoing Hip Replacement

ABSTRACT Objective: To investigate the effects of lumbosacral plexus block combined with general anesthesia on cognitive function, oxidative stress and hemodynamics in elderly patients undergoing hip replacement. Methods: From January 2018 to January 2020, 80 elderly patients who underwent hip replacement in our hospital were selected, they were randomly divided into control group (general anesthesia) and study group (lumbosacral plexus block under the guidance of ultrasound on the basis of general anesthesia), 40 cases in each group. The cognitive function, oxidative stress, hemodynamics, pain condition and adverse reactions were compared between the two groups. Results: The heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO₂) of the two groups decreased and then increased at 10 minutes after anesthesia ~ awake after operation(P<0.05). SpO₂, MAP and HR of the study group were higher than those of the control group at 10 minutes after anesthesia(P<0.05). Superoxide dismutase (SOD) of the two groups decreased and then increased from 1 d before operation to 3 d after operation, malondialdehyde (MDA) increased and then decreased(P<0.05). SOD of the study group was higher than that of the control group at 1 d after operation and 3 d after operation, MDA was lower than those of the control group (P<0.05). The scores of mini-mental state examination (MMSE) of the two groups decreased first and then increased at 1 d before operation and 3 d after operation, but the scores of the study group 1d after operation and 3 d after operation were higher than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). The visual analogue scale(VAS) score of the study group were lower than that of the control group at 1 h, 12 h and 24 h after operation (P<0.05). There was no significant difference between the two groups at 48 h after operation(P>0.05). Conclusion: Ultrasound-guided lumbosacral plexus block combined with general anesthesia can effectively reduce blood flow fluctuation, oxidative stress and cognitive impairment in elderly patients with hip arthroplasty, meanwhile, it can also reduce early postoperative pain, with good safety.