术前下肢神经阻滞对老年全膝置换术后认知的影响
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摘要
目的探讨术前下肢神经阻滞对全麻下老年全膝关节置换术患者术后认知的影响。方法117例行全膝关节置换术的老年患者,随机分为全麻对照组(n=38)、术前阻滞组(n=39)和术后阻滞组(n=40),术前阻滞组患者在麻醉诱导前即刻,于超声引导下将0.375%罗哌卡因20 ml注射于股神经周围,术后阻滞组患者在术毕即刻,于超声引导下行单次股神经阻滞,方法同术前阻滞组。分别于术前(T_0)和术后6 h(T_1)、12 h(T_2)、1 d(T_3)、3 d(T_4)及7 d(T_5),检测血清S100β蛋白水平,分别于T_0~T_5时,进行简易智力状况检查法(MMSE)评分。结果术前阻滞组和术后阻滞组患者T_1~T_5时血清S100β蛋白水平均低于全麻对照组,且术前阻滞组患者T_1~T_5时血清S100β蛋白水平均低于术后阻滞组(P<0.05);术前阻滞组和术后阻滞组T_1~T_5时MMSE评分均高于全麻对照组,且术前阻滞组患者T_1~T_4时MMSE评分均高于术后阻滞组(P<0.05);术前阻滞组患者瑞芬太尼用量和丙泊酚用量均少于术后阻滞组和全麻对照组,镇痛补救率均低于术后阻滞组和全麻对照组(P<0.05)。结论术前下肢神经阻滞可改善全麻下老年全膝关节置换术患者术后认知功能。
Objective To investigate the efficacy of preoperative lower extremity nerve block on postoperative cognition in elderly patients undergoing total knee artbroplasty under general anesthesia.Methods In this study117 cases of elderly patients undergoing total knee artbroplasty were divided into general anesthesia control group(n=38),preoperative block group(n=39)and postoperative block group(n=40).The patients in the preoperative block group were injected with 20 ml of 0.375%Ropivacaine around the femoral nerve under ultrasound guidance immediately before induction of anesthesia,while the patients in the postoperative block group had the same femoral nerve block immediately after surgery.The serum level of S100βprotein was detected before surgery(T_0),6 h(T_1),12 h(T_2),1 d(T_3),3 d(T_4)and 7 d(T_5)after surgery.At T_0,T_1,T_3,T_4 and T_5,the MMSE scores were evaluated respectively.Results The serum levels of S100βprotein at T_1-T_5 in the preoperative block group and the postoperative block group were lower than those in the general anesthesia control group,and the serum levels of S100βprotein at T_1-T_5 in the preoperative block group were lower than the postoperative block group(P<0.05).The MMSE scores at T_1-T_5 in the preoperative block group and the postoperative block group were higher than those in the general anesthesia control group,and the MMSE scores at T_1-T_4 in the preoperative block group were higher than those in the postoperative block group(P<0.05).The dosages of Remifentanil and Propofol in the preoperative block group were lower than those in the postoperative block group and the general anesthesia control group,the analgesic remedy rate was lower than that in the postoperative block group and the general anesthesia control group(P<0.05).The postoperative incidences of nausea and vomiting in the preoperative block group were significantly lower than those in the general anesthesia control group(P<0.05).Conclusions Preoperative lower extremity nerve block could improve the postoperative cognitive function of elderly patients undergoing total knee artbroplasty under general anesthesia.
Objective To investigate the efficacy of preoperative lower extremity nerve block on postoperative cognition in elderly patients undergoing total knee artbroplasty under general anesthesia.Methods In this study117 cases of elderly patients undergoing total knee artbroplasty were divided into general anesthesia control group(n=38),preoperative block group(n=39)and postoperative block group(n=40).The patients in the preoperative block group were injected with 20 ml of 0.375%Ropivacaine around the femoral nerve under ultrasound guidance immediately before induction of anesthesia,while the patients in the postoperative block group had the same femoral nerve block immediately after surgery.The serum level of S100βprotein was detected before surgery(T_0),6 h(T_1),12 h(T_2),1 d(T_3),3 d(T_4)and 7 d(T_5)after surgery.At T_0,T_1,T_3,T_4 and T_5,the MMSE scores were evaluated respectively.Results The serum levels of S100βprotein at T_1-T_5 in the preoperative block group and the postoperative block group were lower than those in the general anesthesia control group,and the serum levels of S100βprotein at T_1-T_5 in the preoperative block group were lower than the postoperative block group(P<0.05).The MMSE scores at T_1-T_5 in the preoperative block group and the postoperative block group were higher than those in the general anesthesia control group,and the MMSE scores at T_1-T_4 in the preoperative block group were higher than those in the postoperative block group(P<0.05).The dosages of Remifentanil and Propofol in the preoperative block group were lower than those in the postoperative block group and the general anesthesia control group,the analgesic remedy rate was lower than that in the postoperative block group and the general anesthesia control group(P<0.05).The postoperative incidences of nausea and vomiting in the preoperative block group were significantly lower than those in the general anesthesia control group(P<0.05).Conclusions Preoperative lower extremity nerve block could improve the postoperative cognitive function of elderly patients undergoing total knee artbroplasty under general anesthesia.
引文
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[10]LI L,FENG J,XIE S H,et al.Preemptive submucosal infiltration with ropivacaine for uvulopalatopharyngoplasty[J].Otolaryngol Head Neck Surg,2014,151(5):874-879.
[11]SINGH H,KUNDRA S,SINGH R M,et al.Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy[J].JAnaesthesiol Clin Pharmacol,2013,29(4):478-484.
[2]阮侠,徐仲煌,唐帅,等.老年髋关节骨折手术3种不同麻醉方式的预后比较[J].基础医学与临床,2015,35(5):695-699.
[3]彭周全,张卫,李丽伟.下肢神经阻滞联合全麻与全麻下膝关节置换术老年病人术后早期认知功能的比较[J].中华麻醉学杂志,2014,34(12):1498-1499.
[4]SHOAIR O A,GRASSO II MP,LAHAYE L A,et al.Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery:A prospective study[J].JAnaesthesiol Clin Pharmacol,2015,31(1):30-36.
[5]MUROUCHI T,IWASAKI S,YAMAKAGE M.Chronological changes in ropivacaine concentration and analgesic effects between transversus abdominis plane block and rectus sheath block[J].Reg Anesth Pain Med,2015,40(5):568-571.
[6]SONG J,LI L,YU P,et al.Preemptive scalp infiltration with 0.5%ropivacaine and 1%lidocaine reduces postoperative pain after craniotomy[J].Acta Neurochir(Wien),2015,157(6):993-998.
[7]黄奕,林成新.右美托咪定复合罗哌卡因超前镇痛对全膝关节置换术患者术后镇痛效果的观察[J].广西医科大学学报,2015,32(1):70-73.
[8]PAPA L,RAMIA M M,EDWARDS D,et al.Systematic review of clinical studies examining biomarkers of brain injury in athletes after sports-related concussion[J].J Neurotrauma,2015,32(10):661-673.
[9]汪文琴,赵为禄,罗佛全,等.右美托咪定与咪达唑仑对老年患者术后血清S100β蛋白水平的影响[J].临床麻醉学杂志,2014,30(10):946-949.
[10]LI L,FENG J,XIE S H,et al.Preemptive submucosal infiltration with ropivacaine for uvulopalatopharyngoplasty[J].Otolaryngol Head Neck Surg,2014,151(5):874-879.
[11]SINGH H,KUNDRA S,SINGH R M,et al.Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy[J].JAnaesthesiol Clin Pharmacol,2013,29(4):478-484.