摘要
目的 探讨老年患者髂腰肌平面阻滞对髋关节术后疼痛及谵妄的影响。方法 选择2021年4月至2024年4月海口市中医医院实施老年髋关节手术的患者98例,采用随机数字表法分为观察组(n=49)和对照组(n=49),对照组实施髂筋膜间隙阻滞联合全身麻醉,观察组实施髂腰肌平面阻滞联合全身麻醉。比较两组患者的心率(Heart rate, HR)、平均动脉压(Mean arterial pressure, MAP)、视觉模拟评分、简易精神状态量表(Mini-mental state examination, MMSE)评分、血清白细胞介素-6(Interleukin-6, IL-6)、肿瘤坏死因子α(Tumor necrosis factor-α, TNF-α)、皮质醇(Cortisol, Cor)水平和不良反应发生情况。结果 观察组穿刺时间短于对照组(P<0.05)。术中不同时点,两组患者HR及MAP比较,差异无统计学意义(P>0.05)。术后2、24、72 h,观察组静息时和抬髋15°时的视觉模拟评分低于对照组(P<0.05)。术后72 h、术后1周,观察组和对照组静息时、抬髋15°时的视觉模拟评分低于术后2 h和术后24 h(P<0.05)。两组患者术后MMSE评分比较,差异无统计学意义(P>0.05);观察组术后谵妄发生率低于对照组(P<0.05)。术后24 h,两组患者血清IL-6、TNF-α、Cor水平较术前升高,观察组低于对照组(P<0.05)。两组患者术后均未见严重不良反应。结论 相较于髂筋膜间隙阻滞联合全身麻醉,髂腰肌平面阻滞联合全身麻醉更有助于减轻患者术后的疼痛反应,降低谵妄的发生风险,且安全性良好。
Objective To explore the effect of iliopsoas muscle plane block on postoperative pain and delirium in elderly patients undergoing hip joint surgery.Methods A total of 98 elderly patients who underwent hip joint surgery at the hospital from April 2021 to April 2024 were selected and divided into the observation group(n=49)and the control group(n=49)using a random number table method.The control group received iliac fascia block combined with general anesthesia,while the observation group received iliopsoas plane block combined with general anesthesia.The heart rate(HR),mean arterial pressure(MAP),pain score,Mini-Mental State Examination(MMSE)score,serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and cortisol(Cor)levels were compared between the 2 groups.Adverse reactions and complications were recorded.Results The puncture time of the observation group was shorter than that of the control group(P<0.05).At different time points during the operation,there was no statistically significant difference in HR and MAP between the 2 groups(P>0.05).At 2 hours,24 hours and 72 hours after the surgery,the pain level scores of the observation group at rest and 15°hip lift were lower than those of the control group(P<0.05).72 hours and 1 week after the surgery,the pain levels at rest and 15°hip lift in the observation group and control group were lower than those at 2 hours and 24 hours after the surgery(P<0.05).There was no statistically significant difference in MMSE scores between the 2 groups after the surgery(P>0.05).The incidence of postoperative delirium in the observation group was lower than that in the control group(P<0.05).24 hours after the surgery,the levels of serum IL-6,TNF-αand Cor in both groups were increased compared to preoperative levels,and the observation group was lower than the control group(P<0.05).No serious adverse reactions or complications were observed in both groups after the surgery.Conclusion Compared to iliac fascia block combined with general anesthesia,iliopsoas plane block combined with general anesthesia is more effective in reducing postoperative pain responses,lowering the risk of delirium,and demonstrating good safety.
作者
卢月霞
张燕
刘永利
LU Yuexia;ZHANG Yan;LIU Yongli(Anesthesiology Department,Haikou Traditional Chinese Medicine Hospital,Haikou 570000,China;Orthopedics Department,Haikou Traditional Chinese Medicine Hospital,Haikou 570000,China)
出处
《新疆医科大学学报》
2025年第5期647-651,共5页
Journal of Xinjiang Medical University
基金
海南省卫生健康行业科研项目(22A200323)。
关键词
髂腰肌平面阻滞
髋关节手术
疼痛
谵妄
iliopsoas muscle plane block
hip joint surgery
pain
delirium
