文章摘要
毛东豫,黄 腾,苏 海,蔡靓羽,徐敏逸,齐敦益.腰丛-坐骨神经阻滞联合七氟烷吸入麻醉对老年髋关节置换术患者术后应激反应、凝血功能和认知功能的影响[J].,2022,(20):3946-3950
腰丛-坐骨神经阻滞联合七氟烷吸入麻醉对老年髋关节置换术患者术后应激反应、凝血功能和认知功能的影响
Effects of Lumbar Plexus Sciatic Nerve Block Combined with Sevoflurane Inhalation Anesthesia on Postoperative Stress Response, Coagulation Function and Cognitive Function
投稿时间:2022-06-08  修订日期:2022-06-30
DOI:10.13241/j.cnki.pmb.2022.20.029
中文关键词: 腰丛-坐骨神经阻滞  七氟烷  吸入麻醉  老年  髋关节置换术  应激反应  凝血功能  认知功能
英文关键词: Lumbar plexus sciatic nerve block  Sevoflurane  Inhalation anesthesia  Elderly  Hip replacement  Stress response  Coagulation function  Cognitive function
基金项目:江苏省中医药局科技项目(LZ13120)
作者单位E-mail
毛东豫 徐州医科大学麻醉学院 江苏 徐州 221000南京中医药大学无锡附属医院麻醉科 江苏 无锡 214000 Maodongyu1345@163.com 
黄 腾 南京中医药大学无锡附属医院麻醉科 江苏 无锡 214000  
苏 海 南京中医药大学无锡附属医院麻醉科 江苏 无锡 214000  
蔡靓羽 南京中医药大学无锡附属医院麻醉科 江苏 无锡 214000  
徐敏逸 南京中医药大学无锡附属医院麻醉科 江苏 无锡 214000  
齐敦益 徐州医科大学麻醉学院 江苏 徐州 221000  
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中文摘要:
      摘要 目的:探讨腰丛-坐骨神经阻滞联合七氟烷吸入麻醉对老年髋关节置换术患者术后应激反应、凝血功能和认知功能的影响。方法:研究纳入2020年6月~2021年6月期间在南京中医药大学无锡附属医院行髋关节置换术的老年患者100例,根据随机数字表法分为对照组(n=50)和研究组(n=50),对照组手术麻醉采用全麻,研究组采用腰丛-坐骨神经阻滞联合七氟烷吸入麻醉,对比两组麻醉后恢复室滞留时间、开始下床活动时间、凝血功能、应激反应、认知功能和不良反应发生率。结果:麻醉诱导后10 min(T1)~术毕(T3)时间点,两组心率(HR)、平均动脉压(MAP)先下降后升高,且研究组T1~T3时间点HR、MAP均低于对照组(P<0.05)。研究组的麻醉后恢复室滞留时间、开始下床活动时间均较对照组更短(P<0.05)。术后1 d~术后7 d,两组纤维蛋白原(FIB)、血小板计数(PLT)先升高后下降,活化部分酶血活酶时间(APTT)、凝血酶原时间(PT)先缩短后延长,且研究组术后1 d~术后7 d的FIB、PLT低于对照组,APTT、PT长于对照组(P<0.05)。术后1 d~术后7 d,两组肾上腺素(NE)、皮质醇(Cor)水平先升高后下降,且研究组术后1 d~术后7 d的NE、Cor水平均低于对照组(P<0.05)。术后1 d~术后7 d,两组简易精神状态量表(MMSE)评分先下降后升高,且术后1 d~术后7 d研究组的MMSE评分较对照组高(P<0.05)。两组不良反应发生率组间对比,统计学差异不显著(P>0.05)。结论:老年髋关节置换术患者应用腰丛-坐骨神经阻滞联合七氟烷吸入麻醉,可降低术后应激反应,减轻凝血功能和认知功能损害,缩短麻醉后恢复室滞留时间、开始下床活动时间,有利于患者术后恢复。
英文摘要:
      ABSTRACT Objective: To investigate the effects of lumbar plexus sciatic nerve block combined with sevoflurane inhalation anesthesia on postoperative stress response, coagulation function and cognitive function in elderly patients undergoing hip arthroplasty. Methods: The study included 100 elderly patients who underwent hip arthroplasty in our hospital from June 2020 to June 2021. According to the random number table method, they were divided into control group (n=50) and study group (n=50). The operation anesthesia in the control group was general anesthesia, and the study group was lumbar plexus sciatic nerve block combined with sevoflurane inhalation anesthesia. The retention time in recovery room after anesthesia, the time of getting out of bed activity, coagulation function, stress response, cognitive function and the incidence of adverse reactions were compared between the two groups. Results: The heart rate (HR) and mean arterial pressure (MAP) decreased first and then increased in the two groups at the time point of 10 min (T1) ~ T3 after anesthesia induction, and HR and MAP in the study group were lower than those in the control group at the time point of T1-T3 (P<0.05). The retention time in recovery room after anesthesia and the time of getting out of bed activity in the study group were shorter than those in the control group (P<0.05). From 1 d to 7 d after operation, fibrinogen (FIB) and platelet count (PLT) increased first and then decreased in two groups, the activated partial enzyme hemolytic enzyme time (APTT) and prothrombin time (PT) were firstly shortened and then prolonged, and FIB and PLT in the study group were lower than those in the control group from 1 d to 7 d after operation, APTT and PT were longer than those in the control group (P<0.05). From 1 d to 7 d after operation, the levels of epinephrine (NE) and cortisol (Cor) in the two groups first increased and then decreased, and the levels of NE and Cor in the study group from 1 d to 7 d after operation were lower than those in the control group (P<0.05). From 1 d to 7 d after operation, the Mini-Mental State Examination (MMSE) score in the two groups decreased first and then increased, and the MMSE score in the study group was higher than that in the control group from 1 d to 7 d after operation (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Lumbar plexus sciatic nerve block combined with sevoflurane inhalation anesthesia in elderly patients with hip replacement can reduce postoperative stress response, reduce coagulation and cognitive impairment, shorten the retention time in recovery room after anesthesia and the time of getting out of bed, which is conducive to postoperative recovery of patients.
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