腰丛联合坐骨神经阻滞对老年患者髋关节术后认知功能与血浆 S100β的影响

摘要

目的：观察腰丛联合坐骨神经阻滞复合全身麻醉对老年患者髋关节术后认知功能与血浆 S100β的影响。方法择期行髋关节手术的老年患者60例，ASA Ⅱ或Ⅲ级，年龄65～85岁，按随机数字表法分为两组，每组30例。G 组患者常规气管插管全麻，L 组患者在超声引导下行腰丛及骶旁坐骨神经阻滞后行气管插管全麻。评估术前、术后1、3、7 d 的 MMSE 评分；检测术前、术后1 h、7 d 晨08：00时颈内静脉血浆 S100β浓度。记录术中低血压发生情况。结果术后1 d，两组 MMSE评分均明显低于术前，且 G 组明显低于 L 组（P＜0.05）；术后3 d，G 组 MMSE 评分明显低于术前（P＜0.05）。G 组有18例（56.7％）POCD，明显高于 L 组的10例（33.3％）（P＜0.05）。术后1 h，两组血浆 S100β浓度均明显高于术前，且 G 组明显高于 L 组（P＜0.05）。术中低血压发生率两组差异无统计学意义。结论腰丛联合骶旁坐骨神经阻滞可有效降低老年患者髋关节手术的应激反应，降低POCD 发生率。%Objective To observe the impacts of lumbar plexus block combined with sciatic nerve block on postoperative cognitive function and plasma S100βlevel in eldly patients undergoing hip surgeries.Methods Sixty patients of ASA Ⅱ or Ⅲ aged 65-85 years,undergoing selective hip sur-geries,were randomly divided into 2 groups (n=30 each).Group G received general anesthesia with tracheal intubation,while group L received ultrasound-guided lumbar plexus block and parasacral sci-atic nerve block combined with general anesthesia.The mini-mental state examination (MMSE)score was recorded before anesthesia,1 d,3 d and 7 d after operation.The plasma S100βlevel was detected before anesthesia,1 h and 7 d after operation.Results The MMSE scores declined on 1 d after oper-ation in both groups(P <0.05),and the value was lower in group G(P <0.05).There were 18 (56.7%)patients diagnosed with POCD in group G at the first day postoperatively,while it was 10 (33.3%)in group L,and the difference was significant(P<0.05).The MMSE scores were still low-er at 3 d after operation (P<0.05).The concentrations of plasma S100βincreased in both groups at 1 h after operation,and it was more obviously in group G (P <0.05).Conclusion Lumbar plexus block combined with parasacral sciatic nerve block might reduce the stress reaction and dosages of general anesthetics in eldly patients undergoing hip surgeries,minimize the damages of central nervous system,protect the cognitive function and reduce the incidence of POCD.