摘要
目的探讨髂筋膜间隙阻滞(FICB)对老年患者髋关节骨术后谵妄的影响。方法选取接受全髋关节置换术的85例老年患者,采用随机数字表法分为髂筋膜间隙阻滞联合全身麻醉组(试验组)和常规全身麻醉组(对照组)。手术后连续3 d观察谵妄的发生率、评估视觉模拟量表(VAS)评分。比较两组患者术前和术后24 h的血清白介素(IL)-1β、IL-6和C反应蛋白(CRP)水平。结果试验组术后3 d发生谵妄8例(19.05%),明显低于对照组21例(48.84%),差异有统计学意义(χ^(2)=7.91,P<0.05);试验组术后24 h的血清IL-1β、IL-6和CRP水平明显低于对照组,差异均有统计学意义(t分别=13.47、14.89、14.26,P均<0.05);试验组患者的VAS评分在术后当天、术后2 d和术后3 d均明显低于对照组,差异均有统计学意义(t分别=12.70、15.06、13.94,P均<0.05)。结论FICB联合全身麻醉应用于老年患者全髋关节置换可以降低术后谵妄的发生率,其机制可能是术后有效的镇痛及血清中较低的炎症因子水平。
Objective To evaluate the effect of fascia iliaca compartment block on the incidence of postoperative delirium after total hip arthroplasty in elderly patients.Methods Eighty-five elderly patients undergoing total hip arthroplasty were randomly divided into two groups:fascia iliaca compartment block combined with general anesthesia group(the experimental group)and general anesthesia group(the control group).The incidence of delirium and visual analogue scale(VAS)score were observed for three days after operation.The inflammatory factors,IL-1β,IL-6,C-reactive protein(CRP)were measured before and 24 hours after operation.Results Eight patients(19.05%)occurred postoperative delirium in the experimental group at 3 days after operation,which was significantly lower than 21 patients(48.84%)in the control group(χ^(2)=7.91,P<0.05).The serum levels of IL-1β,IL-6 and CRP in the experimental group were significantly lower than those in the control group at 24 hours after operation(t=13.47,14.89,14.26,P<0.05).The VAS score of the experimental group were significantly lower than that of the control group before operation,2 days and 3 days after operation(t=12.70,15.06,13.94,P<0.05).Conclusion Fascia iliaca compartment block combined with general anesthesia in elderly patients with total hip arthroplasty can reduce the incidence of postoperative delirium through the effective postoperative analgesia and lower serum levels of inflammatory factors.
作者
安小凤
王兆
方良勤
来津
谭俊铭
AN Xiaofeng;WANG Zhao;FANG Liangqin(Department of Anesthesiology,the 72nd Group Army Hospital of PLA,Huzhou 313000,China)
出处
《全科医学临床与教育》
2021年第7期612-615,共4页
Clinical Education of General Practice
基金
2019湖州市科技计划项目(2019GYB11)
2018浙江省医学会临床科研资金项目(2018ZYC-A78)。
关键词
髂筋膜间隙阻滞
髋部骨折
老年
术后谵妄
fascia iliaca compartment block
hip fracture
elderly
postoperative delirium
