[1]肖水亮,周红社.神经刺激仪引导定位坐骨神经-股神经阻滞对老年全髋置换术患者术后认知功能障碍的影响[J].中国医学物理学杂志,2018,35(9):1094-1098.[doi:10.3969/j.issn.1005-202X.2018.09.018]
　XIAO Shuiliang,ZHOU Hongshe.Effect of nerve stimulator-guided sciatic nerve-femoral nerve block on cognitive impairment inelderly patients after total hip arthroplasty[J].Chinese Journal of Medical Physics,2018,35(9):1094-1098.[doi:10.3969/j.issn.1005-202X.2018.09.018]
点击复制

神经刺激仪引导定位坐骨神经-股神经阻滞对老年全髋置换术患者术后认知功能障碍的影响()
分享到：

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
35卷
期数:
2018年第9期
页码:
1094-1098
栏目:
医学生物物理
出版日期:
2018-09-27

文章信息/Info

Title:
Effect of nerve stimulator-guided sciatic nerve-femoral nerve block on cognitive impairment inelderly patients after total hip arthroplasty
文章编号:
1005-202X（2018）09-1094-05
作者:
肖水亮; 周红社
西安高新医院麻醉科，陕西西安710075
Author(s):
XIAO Shuiliang;  ZHOU Hongshe
Department of Anesthesiology, Xi’an Gaoxin Hospital, Xi’an 710075, China
关键词:
老年患者; 全髋置换术; 神经刺激仪; 坐骨神经-股神经阻滞; 认知功能障碍
Keywords:
Keywords: elderly patient;  total hip arthroplasty;  nerve stimulator;  sciatic nerve-femoral nerve block;  cognitive impairment
分类号:
R614
DOI:
10.3969/j.issn.1005-202X.2018.09.018
文献标志码:
A
摘要:
目的：探讨神经刺激仪引导定位坐骨神经-股神经阻滞对老年全髋置换术患者术后认知功能障碍、血流动力学等的影响，为老年全髋置换术患者制定合理麻醉方案提供参考。方法：以2015年1月~2017年1月西安高新医院收治的86例老年全髋置换术患者为对象，依据麻醉方案不同分为对照组（实施硬膜外麻醉, n=45）和观察组（实施神经刺激仪引导定位坐骨神经-股神经阻滞麻醉, n=41）。观察两组不同时间点［入室后（T0）、手术即刻（T1）、手术开始后30 min（T2）、手术结束后（T3）］的血流动力学指标［平均动脉压（MAP）、心率］变化，比较两组麻醉效果（镇痛维持时间、达到最高阻滞平面时间）、认知功能障碍［简易智能量表（MMSE）评估］、不良反应发生情况。结果：T0时，两组的MAP、心率和术前MMSE评分相比较无明显差异（P>0.05）。与T0 相较，T1、T2、T3 时，两组MAP均明显降低；T1、T2 时，仅对照组心率明显降低（P<0.05）。对照组各时点MAP、心率变化幅度较观察组明显大（P<0.05）。与对照组相比较，观察组的镇痛维持时间明显长，达最高阻滞平面时间明显短（P<0.05）；术后1、7 d，观察组MMSE评分均较对照组明显高（P<0.05）；观察组不良反应总发生率为21.95%，明显低于对照组的44.44%（P<0.05）。结论：神经刺激仪引导定位坐骨神经-股神经阻滞对老年全髋置换术患者的麻醉效果佳，有效减轻患者术后认知功能障碍，对血流动力学干扰少且安全性好。
Abstract:
Abstract: Objective To investigate the effects of nerve stimulator- guided sciatic nerve- femoral nerve block on cognitiveimpairment and hemodynamics in elderly patients after total hip arthroplasty for providing some references for the developmentof a reasonable anesthesia regimen for elderly patients receiving total hip arthroplasty. Methods A total of 86 elderly patientsundergoing total hip arthroplasty in Xi’an Gaoxin Hospital from January 2015 to January 2017 were selected as the subjects.According to different anesthesia regimens, the patients were divided into control group (given epidural anesthesia, n=45) andobservation group (given nerve stimulator-guided sciatic nerve-femoral nerve block anesthesia, n=41). The changes ofhemodynamic indexes, including mean arterial pressure (MAP) and heart rate, in the two groups at different time points［enteringthe operating room (T0), the beginning of operation (T1), 30 minutes after the beginning of operation (T2), the end of operation(T3)］were analyzed. The anesthetic effects (duration of analgesia, time to the highest block level), cognitive impairment［minimentalstate examination (MMSE)］and adverse reactions were compared between two groups. Results No significant differenceswere found in MAP, heart rate and preoperative MMSE score between two groups at T0 (P>0.05). The MAP of both two groupswas significantly decreased at T1, T2 and T3 as compared with T0. At T1 and T2, only the heart rate of control group wasdecreased significantly (P<0.05). The changes of MAP and heart rate in control group at different time points were significantlygreater than those in observation group (P<0.05). The duration of analgesia was significantly longer and the time to the highestblock level was shorter in observation group as compared with control group (P<0.05). The MMSE scores in observation groupat 1 day and 7 days after finishing operation were significantly higher than those in control group (P<0.05). The total incidenceof adverse reactions in observation group was 21.95%, significantly lower than 44.44% in control group (P<0.05). Conclusion Nerve stimulator- guided sciatic nerve- femoral nerve block not only has remarkable anesthetic effects for elderly patientsundergoing total hip arthroplasty, but also effectively reduces postoperative cognitive impairment, with high safety and little effectson hemodynamics.

相似文献/References:

[1]赵丽,赵曙光,张排旗,等. 彩色多普勒超声联合磁共振胆胰管成像诊断老年胆总管结石270例临床分析[J].中国医学物理学杂志,2016,33(9):909.[doi:10.3969/j.issn.1005-202X.2016.09.008]
　[J].Chinese Journal of Medical Physics,2016,33(9):909.[doi:10.3969/j.issn.1005-202X.2016.09.008]
[2]孙柯,梁丽萍,呼小雪,等.及早经皮穴位电针刺激对高龄老年髋部骨折术后认知的影响[J].中国医学物理学杂志,2018,35(9):1075.[doi:10.3969/j.issn.1005-202X.2018.09.015]
　SUN Ke,LIANG Liping,HU Xiaoxue,et al.Effects of early transcutaneous acupoint electrical stimulation on postoperative cognition ofelderly patients with hip fractures[J].Chinese Journal of Medical Physics,2018,35(9):1075.[doi:10.3969/j.issn.1005-202X.2018.09.015]

备注/Memo

备注/Memo:
【收稿日期】2018-04-02【作者简介】肖水亮，主治医师，研究方向：临床麻醉，E-mail: 2165751935@qq.com
更新日期/Last Update: 2018-09-28