邓楚娇 1刘可可 1王嘉争 1石小乔 1邓丁玲 1王燕1
作者信息
- 1. 南华大学附属第二医院麻醉科,湖南衡阳 421000
- 折叠
摘要
Abstract
Objective To observe whether preoperative continuous fascia iliaca compartment block(CFICB)for preoperative analgesia can reduce the incidence of postoperative delirium(POD)in elderly patients with hip fracture,and to explore the relationship between in-flammatory response and POD by detecting the levels of related inflammatory cytokines.Methods A total of 80 elderly hip fracture pa-tients aged 65-85 years with ASA Ⅱ or Ⅲ in the Second Affiliated Hospital of Nanhua University were selected and divided into nerve block group(group A,n=40)and conventional analgesia group(group B,n=40)by random number table method.Group A received CFICB,group B received ibuprofen static drops(2 times/d)according to clinical requirements and patient needs.The two groups of pa-tients received combined spinal-epidural anesthesia before surgery,and patient-controlled epidural analgesia was given for 48 h after the operation.The NRS score and the number of perioperative rescue analgesics taken from the two groups of patients were evaluated and recorded at admission(T1),30 min after analgesia(T2),during positioning before anesthesia(T3),after surgery(T4),and 72 h after surgery(T5)at rest and during exercise.The occurrence of preoperative analgesia-related adverse reactions in the two groups was observed and recorded.Meanwhile,the patient's preoperative waiting time and the length of hospital stay were recorded.At T1,T3,T4,and T5,the venous blood of the two groups of patients was drawn,and the serum IL-6 and IL-10 concentrations were measured.The basic cognitive function of the patients before surgery was assessed by the Simple Mental State Examination Scale;the occurrence of delirium on the day after surgery,1 d,and 3 d after surgery was assessed by the Consciousness Disorder Test.Results At T2 and T3,the NRS scores of patients in group B at rest and during exercise were higher than those in group A(P＜0.05).Compared with group B,perioper-ative rescue analgesics taken in group A was significantly reduced(P＜0.05),and the incidence of preoperative analgesia-related adverse reactions in group B was higher than that in group A(P＜0.05).At T3 and T4,the level of IL-6 in group A was lower than that in group B,and the level of IL-10 in group A at T3 was higher than that in group B(P＜0.05).The incidence of delirium in group A was lower than that in group B(P＜0.05).Conclusion Compared with conventional analgesics,preoperative CFICB can effectively relieve preoperative pain in elderly patients with hip fracture,and reduce the incidence of postoperative delirium,which may be related to the inhibition of perioperative inflammatory response.关键词
髂筋膜间隙阻滞/术前镇痛/髋部骨折/炎症反应/术后谵妄Key words
fascial iliac compartment block/preoperative analgesia/hip fractures/inflammatory response/postoperative delirium
