Objective: To investigate the effect of perioperative analgesia on early cognitive impairment (POCD) in elderly patients with femoral neck fracture after hip replacement.Methods: Sixty patients with femoral neck fractures undergoing hip arthroplasty admitted to our department from March 2017 to June 2018 were randomly divided into two groups, 30 in each. A group (30 cases) used continuous iliac fascia block analgesia before operation, B group (30 cases) used continuous iliac fascia block analgesia after operation. Using simple intelligence mental scale (MMSE), visual analogue scale (VAS) perioperative awareness of the two groups of patients was assessed. The degree of function and pain, and the incidence of POCD in the two groups were compared.Results: There was no significant difference in the operation time, ropivacaine dosage, intraoperative blood loss between the two groups[(113.5±0.7)min vs(120.8±0.9)min, (72.1±13.5)μg vs(71.5±12.5)μg, (136.5±21.7) ml vs (140.2±22.5) ml, P>0.05]. The MMSE scores of group A were higher in T1-T4 than in group B (P<0.05), and the VAS scores were lower in T0-T4 than in group B (P<0.05). The incidence of POCD was 10.00% in group A and 27.67% in group B. The difference between the two groups was statistically significant (P<0.05). The postoperative complication rate was 6.67% in group A and 10.00% in group B. There was no significant difference between the two groups (P>0.05). Conclusion: Perioperative use of continuous fascia block analgesia can significantly reduce postoperative pain and the occurrence POCD, and does not increase the dose of anesthetic medication and the risk of postoperative complications. |
[1] TSAI T L,SANDS L P,LEUNG J M.An update on postoperative cognitive dysfunction[J].Adv Anesth,2010,28(1):269-284.
[2] 郑旭,顾小萍.大麻素在认知功能障碍中的作用[J].国际麻醉学与复苏杂志,2013,34(8):760-763.
[3] 吴丹,杨晓明.老年患者围术期认知功能障碍保护的研究进展[J].空军医学杂志,2016,32(4):266-269.
[4] 务军.高龄全膝关节置换的不同镇痛方式:认知功能障碍发生率比较[J].中国组织工程研究,2015,19(26):4139-4143.
[5] DEO H,WEST G,BUTCHER C,et al.The prevalence of cognitive dysfunction after conventional and computer-assisted total knee replacement[J].Knee,2011,18(2):117-120.
[6] 陈岩.右美托咪定联合喷他佐辛对老年患者全髋关节置换术后的镇痛效果及炎症因子、Fib和D-二聚体水平的影响[J].东南大学学报(医学版),2017,36(6):934-937.
[7] 蒋宗明,丛昊,仲俊峰,等.硬膜外阻滞对全麻下腹腔镜胃癌根治术老年病人术后认知功能障碍的影响[J].中华麻醉学杂志,2013,33(9):1056-1058.
[8] 李井柱,李晓征,王晓敏,等.帕瑞昔布钠镇痛对老年急诊股骨头置换术患者神经系统的影响[J].中华医学杂志,2013,93(27):2152-2154.
[9] 黄志莲,李军,连庆泉,等.老年患者髋关节置换术后早期认知功能障碍的因素分析[J].中华麻醉学杂志,2008,28(3):201-204.
[10] 周丘,刘英,许方荣,等.不同麻醉和镇痛方法对老年患者非心脏手术术后早期认知功能的影响[J].中国医学创新,2014,11(25):10-12.
[11] JILDENSTÅL P K,HALLÉN J L,RAWAL N,et al.Effect of auditory evoked potential-guided anaesthesia on consumption of anaesthetics and early postoperative cognitive dysfunction:a randomized controlled trial[J].Eur J Anaesthesiol,2011,28(3):213-219.
[12] 张大志,王东信,穆东亮,等.单次坐骨神经联合连续股神经阻滞镇痛对膝关节置换术后谵妄发生率的影响[J].中国药物警戒,2013,10(4):199-202.
[13] 熊雄,熊双宝,周德祥,等.盐酸氢吗啡酮和吗啡PCEA对高龄患者术后认知功能的影响[J].医学信息,2014,27(33):54-55.
[14] 贺纯静,聂浩雄,郭春芮,等.氟比洛芬酯术后镇痛对老年髋关节置换术患者术后认知功能的影响[J].临床麻醉学杂志,2013,29(1):13-15.
[15] 曾德亮,陈静,张笃文,等.连续股神经阻滞镇痛对老年人全膝关节置换术后早期认知功能的影响[J].贵阳医学院学报,2014,39(3):365-368.
[16] 袁东彬,杨武,赖峰,等.不同麻醉方法对老年患者非心脏手术后早期认知的影响[J].中国现代药物应用,2013,7(3):49-50. |