| 腰丛神经阻滞复合全身麻醉处理老年人髋部骨折术后谵妄的应用研究 |
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Received:December 12, 2022
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| 作者 | Author | 单位 | Unit | E-Mail |
| 肖遥 |
XIAO Yao |
河南省洛阳正骨医院, 河南 洛阳 471002 |
Luoyang Osteopathic-Traumatological Hospital of Henan Province, Luoyang 471002, Henan, China |
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| 陈柯 |
CHEN Ke |
河南省洛阳正骨医院, 河南 洛阳 471002 |
Luoyang Osteopathic-Traumatological Hospital of Henan Province, Luoyang 471002, Henan, China |
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| 田可为 |
TIAN Ke-wei |
河南省洛阳正骨医院, 河南 洛阳 471002 |
Luoyang Osteopathic-Traumatological Hospital of Henan Province, Luoyang 471002, Henan, China |
29564557@qq.com |
| 周旭 |
ZHOU Xu |
河南省洛阳正骨医院, 河南 洛阳 471002 |
Luoyang Osteopathic-Traumatological Hospital of Henan Province, Luoyang 471002, Henan, China |
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| 李敏 |
LI Min |
河南省洛阳正骨医院, 河南 洛阳 471002 |
Luoyang Osteopathic-Traumatological Hospital of Henan Province, Luoyang 471002, Henan, China |
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| 陈森 |
CHEN Sen |
河南省洛阳正骨医院, 河南 洛阳 471002 |
Luoyang Osteopathic-Traumatological Hospital of Henan Province, Luoyang 471002, Henan, China |
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| 张真真 |
ZHANG Zhen-zhen |
河南省洛阳正骨医院, 河南 洛阳 471002 |
Luoyang Osteopathic-Traumatological Hospital of Henan Province, Luoyang 471002, Henan, China |
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| 期刊信息：《中国骨伤》2023年36卷，第8期，第731-736页 |
| DOI：10.12200/j.issn.1003-0034.2023.08.007 |
| 基金项目:河南省中医药科学研究专项课题(编号:20-21ZY2253) |
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目的：探讨腰丛神经阻滞复合全身麻醉提高老年患者髋部骨折手术麻醉镇痛效果,减少镇痛药物使用,减轻炎性反应,避免术后谵妄(postoperative delirium POD)发生。
方法：选取2020年2月至2021年9月接受髋部骨折手术的200例老年患者,根据麻醉方法不同分为观察组与对照组。观察组97例,其中男66例,女31例;年龄(70.23±6.60)岁;身体质量指数(body mass index,BMI)(23.13±1.94) kg·m-2;半髋置换19例,全髋置换46例,转子间骨折固定32例;采取腰丛神经阻滞复合全身麻醉。对照组94例,其中男59例,女35例,年龄(68.80±6.24)岁,BMI (22.88±1.85) kg·m-2;半髋置换14例,全髋置换39例,转子间骨折固定41例;采用单纯施行全身麻醉。9例由于手术方案改变、基础疾病加重脱离研究。比较两组患者术后1、2、3 d的POD发生率,谵妄等级评分(mini-mental state examination,MMSE),静息状态下疼痛视觉模拟评分(visual analogue scale,VAS);术前1 d及术后1、6 h血清C反应蛋白(C-reactive protein,CRP),白细胞介素-1β(interleukin-1β,IL-1β),白细胞介素-6(interleukin-6,IL-6),肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)等炎性因子的水平以及舒芬太尼的使用量。
结果：观察组术后1、2、3 d的POD发生例数少于对照组(P<0.05);观察组MMSE评分高于对照组(P<0.01),VAS低于对照组(P<0.01);两组患者POD发生例数逐天减少、MMSE评分逐天升高(P<0.01);术后1 h,观察组CRP,IL-1β、IL-6、TNF-α水平均低于对照组(P<0.01);术后6 h,观察组CRP、IL-6、TNF-α水平均低于对照组(P<0.01),两组IL-1β比较,差异无统计学意义(P>0.05);观察组舒芬太尼用量少于对照组(P<0.01)。
结论：腰丛神经阻滞复合全身麻醉对比单纯全身麻醉应用于老年人髋部骨折手术,镇痛效果确切,炎症反应轻,能减少阿片类镇痛药物的使用,较少引起患者术后谵妄的概率。 |
| [关键词]:术后谵妄 腰丛神经阻滞 老年患者 髋部骨折 |
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| Lumbar plexus block combined with general anesthesia in treating postoperative delirium of hip fracture in elderly patients |
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Abstract:
Objective To explore lumbar plexus nerve block combined with general anesthesia in elderly patients undergoing hip operation could improve analgesia effect,reduce consumption of analgesics,prevent inflammatory reaction,and avoid postoperative delirium(POD).
Methods Totally 200 elderly patients underwent hip fracture surgery from February 2020 to September 2021 were selected and were divided into observation group and control group according to different anesthesia methods. There were 97 patients in observation group including 66 males and 33 females; aged (70.23±6.60) years old;body mass index (BMI) was (23.13±1.94) kg·m-2;19 patients with hemi arthroplasty,46 patients with total hip arthroplasty,and 32 patients with femur intertrochanteric fixation;treated with lumbar plexus block combined with general anesthesia. There were 94 patients in control group,including 66 males and 33 females;aged (68.80±6.24) years old;BMI was (22.88±1.85) kg·m-2;14 patients with hemi arthroplasty,39 patients with total hip arthroplasty,and 41 patients with femur intertrochanteric fixation;treated with only general anesthesia. Nine patients were separated due to the change of surgical protocol or chronic disease. The incidence of POD at 1,2 and 3 days after surgery,mini-mental state examination (MMSE) score,visual analogue scale (VAS) in resting state,serum inflammatory factors levels[such as C-reactive protein(CRP),interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)] at 1 d before operation,1 and 6 h after surgery,consumption of sufentanil between two groups were compared.
Results The incidences of POD in observation group were lower than control group at 1,2 and 3 days of operation (P<0.05),MMSE score in observation group was higher than that of control group (P<0.05),VAS in observation group was lower than that of control group (P<0.01). The incidences of POD decreased and MMSE score were increaed in both groups day by day (P<0.01). The levels of CRP,IL-1β,IL-6 and TNF-α in observation group were lower than that of control group at 1 h after operation (P<0.01). The levels of CRP,IL-6 and TNF-α in observation group were lower than that of control group at 6 h after operation (P<0.01),while no statisitical difference in IL-1β between two groups(P>0.05). The consumption of sufentanil in observation group was lower than that of control group (P<0.01).
Conclusion Compared with general anesthesia,lumbar plexus nerve block combined with general anesthesia for the operations of hip fracture in elderly patients has better analgesic effect,has advantages of slight inflammatory reaction,and could decrease consumption of opioid and incidence of POD. |
| KEYWORDS:Lumbar plexus nerve block Postoperative delirium Geriatrics Hip fracture |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 肖遥,陈柯,田可为,周旭,李敏,陈森,张真真.腰丛神经阻滞复合全身麻醉处理老年人髋部骨折术后谵妄的应用研究[J].中国骨伤,2023,36(8):731~736 |
| 英文格式: | XIAO Yao,CHEN Ke,TIAN Ke-wei,ZHOU Xu,LI Min,CHEN Sen,ZHANG Zhen-zhen.Lumbar plexus block combined with general anesthesia in treating postoperative delirium of hip fracture in elderly patients[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(8):731~736 |
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