腰丛神经阻滞对老年股骨上段手术患者脑氧代谢及术后认知功能的影响
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摘要
目的探讨腰丛神经阻滞对老年股骨上段手术患者术中脑氧代谢及术后认知功能的影响。方法将择期行股骨上段手术的110例老年患者,采用随机数字表法分为腰丛神经阻滞组(LPB组)与蛛网膜下腔阻滞组(SA组),每组55例。记录两组患者一般资料及术前1d患者的简易智力状态检查量表(MMSE)评分;记录入手术室后、麻醉完成后、手术开始、手术后15、30、60min、手术结束时的脑氧饱和度,以及手术时间和术中不良事件;随访患者术后第7天的MMSE评分,并进行比较和分析。结果两组患者各时点脑氧饱和度比较差异均无统计学意义(均P>0.05);与LPB组相比,SA组患者术中发生低血压及使用血管活性药物的比例明显增加,差异均有统计学意义(均P<0.05);两组患者不同时点MMSE评分比较差异均无统计学意义(均P>0.05),术后第7天术后认知功能障碍发生率无统计学差异(P>0.05)。结论老年患者股骨上段手术麻醉采用腰丛神经阻滞,术中脑氧饱和度和术后认知功能的变化与椎管内麻醉相似,但血流动力学所受影响较小,因此值得临床上推广应用。
Objective To investigate the effect of lumbar plexus block on cerebral oxygen metabolism and postoperative cognitive function in elderly patients with upper femur surgery. Methods One hundred and ten patients with age of 65～80 years and ASA I or II,undergoing elective upper femoral surgery were enrolled in the study. Patients were randomly divided into lumbar plexus block group(LPB group, n=55) and subarachnoid block group(SA group, n=55). The patient's general data and the Mini-mental State Examination(MMSE)score the day before surgery were recorded. The cerebral oxygen saturation were measured at entering the room, completion of anesthesia,surgery incision, 15 min, 30 min, 60 min after incision, and the end of the operation. Meanwhile, the operation time and the intraoperative adverse events were documented. The MMSE scores of patients were followed up on d 7 after surgery. Results There was no significant difference in cerebral oxygen saturation at all time points between the two groups. Compared with the LPB group, the incidence of intraoperative hypotension and vasoactive drugs usage in the SA group was significantly higher(P<0.05). There was no significant difference in MMSE scores between the two groups at all time points. There was no significant difference in the incidence of POCD between the two groups on d 7 after surgery(P >0.05). Conclusion The application of lumbar plexus block in the elderly patients with upper femur surgery has little impact on intraoperative cerebral oxygen saturation and postoperative cognitive function changes, which are similar to these of spinal anesthesia. Therefore, it is worthy of clinical application.
Objective To investigate the effect of lumbar plexus block on cerebral oxygen metabolism and postoperative cognitive function in elderly patients with upper femur surgery. Methods One hundred and ten patients with age of 65～80 years and ASA I or II,undergoing elective upper femoral surgery were enrolled in the study. Patients were randomly divided into lumbar plexus block group(LPB group, n=55) and subarachnoid block group(SA group, n=55). The patient's general data and the Mini-mental State Examination(MMSE)score the day before surgery were recorded. The cerebral oxygen saturation were measured at entering the room, completion of anesthesia,surgery incision, 15 min, 30 min, 60 min after incision, and the end of the operation. Meanwhile, the operation time and the intraoperative adverse events were documented. The MMSE scores of patients were followed up on d 7 after surgery. Results There was no significant difference in cerebral oxygen saturation at all time points between the two groups. Compared with the LPB group, the incidence of intraoperative hypotension and vasoactive drugs usage in the SA group was significantly higher(P<0.05). There was no significant difference in MMSE scores between the two groups at all time points. There was no significant difference in the incidence of POCD between the two groups on d 7 after surgery(P >0.05). Conclusion The application of lumbar plexus block in the elderly patients with upper femur surgery has little impact on intraoperative cerebral oxygen saturation and postoperative cognitive function changes, which are similar to these of spinal anesthesia. Therefore, it is worthy of clinical application.
引文
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[11]杨芳芳,金孝岠.近红外线光谱仪用于脑氧饱和度监测的临床进展[J].国际麻醉学与复苏杂志,2017,38(9):837-841.DOI:10.3760/cma.j.issn.1673-4378.2017.09.016.
[12]Amiri HR,ZamaniMM,Safari S.Lumbar plexus block for management of hip surgeries[J].Anesth Pain Med,2014,4(3):e19407.DOI:10.5812/aapm.19407.
[13]冯宝莹,张习良,游玉媛,等.超声-刺激仪双重引导下多点式前路腰丛阻滞在老年股骨近端骨折手术中的应用[J].中国实用医药,2018,13(5):8-10.DOI:10.14163/j.cnki.11-5547/r.2018.05.004.
[14]古昌剑,彭深渠,张淑芳,等.超声引导腰丛-坐骨神经阻滞与单侧腰麻在老年患者单侧下肢手术中的疗效对比[J].新疆医学,2018,48(3):278-280.
[2]ZywielMG,Prabhu A,Perruccio AV,et al.The influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty:a systematic review[J].Clin Orthop Relat Res,2014,472(5):1453-1466.DOI:10.1007/s11999-013-3363-2.
[3]伍剑锷,汪文华,赖尚树,等.B超引导下神经阻滞麻醉对老年髋关节手术患者神经阻滞效果及认知功能的影响[J].中国老年学杂志,2018,38(9):2130-2133.DOI:10.3969/j.issn.1005-9202.2018.09.034.
[4]Neuman MD,Silber JH,Elkassabany NM,et al.Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults[J].Anesthesiology,2012,117(1):72-92.DOI:10.1097/ALN.0b013e3182545e7c.
[5]Basques BA,Toy JO,Bohl DD,et al.General compared with spinal anesthesia for total hip arthroplasty[J].J Bone Joint Surg Am,2015,18,97(6):455-461.DOI:10.2106/JBJS.N.00662.
[6]Fields AC,Dieterich JD,Buterbaugh K,et al.Short-term complications in hip fracture surgery using spinal versus general anaesthesia[J].Injury,2015,46(4):719-723.DOI:10.1016/j.injury.2015.02.002.
[7]胡晓云,赵斌江,苏跃,等.右美托咪定区域麻醉镇静对糖尿病老年患者术后认知功能的影响[J].中华麻醉学杂志,2017,37(11):1296-1299.DOI:10.3760∕cma.j.issn.0254-1416.2017.11.004.
[8]朱小兵,吴论,彭学强,等.超声引导腰骶丛阻滞联合鼻咽通气道用于合并肺部及腰椎疾病高龄患者髋关节置换术的可行性[J].中华麻醉学杂志,2017,37(7):856-858.DOI:10.3760/cma.j.issn.0254-1416.2017.07.025.
[9]Harilall Y,Adam JK,Biccard BM,et al.The effect of optimising cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery[J].Heart Lung Circ,2014,23(1):68-74.DOI:10.1016/j.hlc.2013.07.002.
[10]Bijker JB,Gelb AW.Review article:the role of hypotension in perioperative stroke[J].Can J Anaesth,2013,60(2):159-167.DOI:10.1007/s12630-012-9857-7.
[11]杨芳芳,金孝岠.近红外线光谱仪用于脑氧饱和度监测的临床进展[J].国际麻醉学与复苏杂志,2017,38(9):837-841.DOI:10.3760/cma.j.issn.1673-4378.2017.09.016.
[12]Amiri HR,ZamaniMM,Safari S.Lumbar plexus block for management of hip surgeries[J].Anesth Pain Med,2014,4(3):e19407.DOI:10.5812/aapm.19407.
[13]冯宝莹,张习良,游玉媛,等.超声-刺激仪双重引导下多点式前路腰丛阻滞在老年股骨近端骨折手术中的应用[J].中国实用医药,2018,13(5):8-10.DOI:10.14163/j.cnki.11-5547/r.2018.05.004.
[14]古昌剑,彭深渠,张淑芳,等.超声引导腰丛-坐骨神经阻滞与单侧腰麻在老年患者单侧下肢手术中的疗效对比[J].新疆医学,2018,48(3):278-280.