| 宋 洁,胡宪文,陈 齐,王家友,刘晓芬,盛 奎,张 杨,吴路楠.超声引导下髂筋膜神经阻滞联合全麻对老年股骨近端骨折患者术后血清疼痛介质PGE2、SP和认知功能及睡眠质量的影响[J].,2022,(23):4536-4540 |
| 超声引导下髂筋膜神经阻滞联合全麻对老年股骨近端骨折患者术后血清疼痛介质PGE2、SP和认知功能及睡眠质量的影响 |
| Effects of Ultrasound-Guided Iliac Fascia Nerve Block Combined with General Anesthesia on Serum Pain Mediators PGE2, SP, Cognitive Function and Sleep Quality in Elderly Patients with Proximal Femoral Fracture |
| 投稿时间：2022-04-23 修订日期：2022-05-17 |
| DOI：10.13241/j.cnki.pmb.2022.23.027 |
| 中文关键词: 超声引导下髂筋膜神经阻滞 老年 全麻 股骨近端骨折 疼痛介质 认知功能 睡眠质量 |
| 英文关键词: Ultrasound-guided iliac fascia nerve block Elderly General anesthesia Proximal femoral fracture Pain mediators Cognitive function Sleep quality |
| 基金项目:安徽省教育厅重大研究项目（KJ2021ZD0030） |
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| 中文摘要: |
| 摘要 目的：观察超声引导下髂筋膜神经阻滞联合全麻对老年股骨近端骨折患者术后血清疼痛介质前列腺素E2（PGE2）、P物质（SP）和认知功能及睡眠质量的影响。方法：选取2018年8月~2021年9月期间我院收治的择期行手术治疗的老年股骨近端骨折患者80例，根据随机数字表法分为对照组（40例，常规全麻方案）和观察组（40例，超声引导下髂筋膜神经阻滞联合全麻方案），对比两组麻醉效果、血流动力学、疼痛情况、认知功能和睡眠质量，观察不同模式麻醉下的安全性。结果：观察组的苏醒及拔管时间均短于对照组，丙泊酚使用量少于对照组（P<0.05）。两组置入喉罩时（T1）~术毕时（T3）心率（HR）先升高后下降，平均动脉压（MAP）先下降后升高（P<0.05）；观察组T1~T3时点HR低于对照组，MAP高于对照组（P<0.05）。两组术后24 h血清PGE2、SP水平和视觉疼痛模拟量表（VAS）评分均升高，但观察组低于对照组（P<0.05）。两组术后1 d、2 d、3 d 蒙特利尔认知评估量表（MoCA）评分较术前先下降后升高（P<0.05）；观察组术后2 d、3 d MoCA评分高于对照组（P<0.05）。两组术后1 d、2 d、3 d匹兹堡睡眠质量评估量表（PSQI）评分较术前先升高后下降（P<0.05）；观察组术后1 d、2 d、3 d PSQI评分低于对照组（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：老年股骨近端骨折患者术中选用超声引导下髂筋膜神经阻滞联合全麻，镇痛效果显著，可稳定机体血流动力学，减少对认知功能和睡眠质量的影响，且安全性良好。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the effects of ultrasound-guided iliac fascia nerve block combined with general anesthesia on serum pain mediators prostaglandin E2 (PGE2) and substance P (SP), cognitive function and sleep quality in elderly patients with proximal femoral fracture. Methods: 80 elderly patients with proximal femoral fractures who were treated by elective surgery in our hospital from August 2018 to September 2021 were selected, and they were divided into and control group (40 cases, conventional general anesthesia) and observation group (40 cases, ultrasound-guided iliac fascia nerve blocke combined with general anesthesia) according to the random number table method. The anesthetic effect, hemodynamics, pain condition, cognitive function and sleep quality of the two groups were compared, the safety of different modes of anesthesia were observed. Results: The wake-up time and extubation time of the observation group were shorter than those of the control group, and the dosage of propofol was less than that of the control group (P<0.05). The heart rate (HR) first increased and then decreased from the time of laryngeal mask implantation (T1) to the time of postoperative (T3) in two groups, and the mean arterial pressure (MAP) first decreased and then increased (P<0.05). HR of the observation group at T1 ~ T3 time point was lower than that of the control group, and MAP was higher than that in the control group (P<0.05). The levels of serum PGE2 and SP and the visual pain scale (VAS) score in the two groups at 24 h after operation increased, and the observation group was lower than the control group (P<0.05). The Montreal Cognitive Assessment Scale (MoCA) score in the two groups at 1 d, 2 d and 3 d after operation decreased first and then increased compared with those before operation (P<0.05). The MOCA scores of the observation group at 2 d and 3 d after operation were higher than those of the control group (P<0.05). The Pittsburgh Sleep Quality Assessment Scale (PSQI) scores in the two groups at 1 d, 2 d and 3 d after operation increased at first and then decreased compared with those before operation (P<0.05). The PSQI scores of the observation group at 1 d, 2 d and 3 d after operation were lower than those of the control group (P<0.05). There was no difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: In elderly patients with proximal femoral fracture, ultrasound-guided iliac fascia nerve block combined with general anesthesia has a significant analgesic effect, which can stabilize the body's hemodynamics, and reduce the impact on cognitive function and sleep quality, with good safety. |
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