Effects of Lumbar Plexus Sciatic Nerve Block Combined with Low-dose Propofol Anesthesia on Hemodynamics, Postoperative Cognitive Function and Complications in Elderly Patients with Intertrochanteric Fracture
摘要【目的】 探讨腰丛-坐骨神经阻滞联合小剂量丙泊酚麻醉对老年股骨粗隆间骨折患者血流动力学、术后认知功能及其并发症的影响。【方法】 选取2017年9月至2019年9月于本院行股骨粗隆间骨折手术患者60例作为研究对象,按随机数表法随机分为观察组、对照组,各30例。对照组在全身麻醉下进行手术,观察组采用腰丛-坐骨神经阻滞联合小剂量丙泊酚麻醉。对比两组患者血流动力学指标[心率(HR)及平均动脉压(MAP)]、术后认知功能[蒙特利尔认知评估量表(MoCA)、简易精神状态量表(MMSE)评分]、麻醉效果及其并发症的发生情况。【结果】 两组患者在T1时段的MAP、HR指标水平较T0明显降低,但只有对照组T1时段MAP水平显著低于观察组,其差异有统计学意义(P>0.05);观察组麻醉效果优良率显著高于对照组(86.67% vs 60.00%),其差异均有统计学意义(P<0.05)。两组患者术后1 d和术后3 d 的MoCA和MMSE评分均较术前降低,但观察组MoCA和MMSE评分均显著高于对照组。且观察组患者并发症发生率显著低于对照组(16.67% vs 40.33%),其差异均有统计学意义(P<0.05)。【结论】 对老年股骨粗隆间骨折患者采用腰丛-坐骨神经阻滞联合小剂量丙泊酚麻醉具有血流动力学稳定、麻醉效果显著等优势,可有效降低患者术后认知功能障碍和术后并发症的发生。
Abstract：【Objective】 To investigate the effect of lumbar plexus sciatic nerve block combined with low-dose propofol anesthesia on hemodynamics, postoperative cognitive function and complications in elderly patients with intertrochanteric fracture.【Methods】 Sixty patients with intertrochanteric fracture in our hospital from September 2017 to September 2019 were selected and randomly divided into observation group and control group (30 cases in each group). The control group was operated under general anesthesia, and the observation group was treated with lumbar plexus sciatic nerve block combined with low-dose propofol anesthesia. The hemodynamic indexes [heart rate (HR) and mean arterial pressure (MAP)], postoperative cognitive function [Montreal Cognitive Assessment Scale (MoCA), Mini Mental State Examination (MMSE) score], anesthetic effect and complications of the two groups were compared.【Results】 The MAP and HR index levels of the two groups at T1 were significantly lower than those at T0, but the map level of the control group at T1 was significantly lower than that of the observation group, and the difference was statistically significant (P>0.05); The excellent and good rate of anesthesia effect in the observation group was significantly higher than that in the control group (86.67% vs 60.00%), and the differences were statistically significant (P<0.05). The MoCA and MMSE scores of the two groups at 1 day and 3 days after operation were lower than those before operation, but the MoCA and MMSE scores of the observation group were significantly higher than those of the control group. The incidence of complications in the observation group was significantly lower than that in the control group (16.67% vs 40.33%), and the differences were statistically significant (P<0.05).【Conclusion】 Lumbar plexus sciatic nerve block combined with low-dose propofol anesthesia for elderly patients with intertrochanteric fracture has the advantages of stable hemodynamics and significant anesthetic effect, which can effectively reduce the occurrence of postoperative cognitive dysfunction and postoperative complications.
郭平, 贺蕾. 腰丛-坐骨神经阻滞联合小剂量丙泊酚麻醉对老年股骨粗隆间骨折患者血流动力学、术后认知功能及并发症的影响[J]. 医学临床研究, 2021, 38(5): 705-708.
GUO Ping, HE Lei. Effects of Lumbar Plexus Sciatic Nerve Block Combined with Low-dose Propofol Anesthesia on Hemodynamics, Postoperative Cognitive Function and Complications in Elderly Patients with Intertrochanteric Fracture. JOURNAL OF CLINICAL RESEARCH, 2021, 38(5): 705-708.
2021, Vol. 38 
