2019 年第 10 期 第 14 卷

局部浸润联合丙泊酚静脉麻醉对老年髋部骨折手术患者认知功能的影响

Effect of local infiltration anesthesia combined with propofol intravenous anesthesia on cognitive function in elderly patients undergoing hip fracture surgery

作者：彭春潮吴婧文光文辉张智卿

英文作者：

单位：810007西宁，青海省人民医院麻醉科（彭春潮、光文辉、张智卿），急诊重症监护病房（吴婧文）

英文单位：

关键词：髋部骨折；认知功能；局部浸润；丙泊酚

英文关键词：

• 摘要：

• 【摘要】目的    探讨局部浸润联合丙泊酚静脉麻醉对老年髋部骨折手术患者认知功能的影响。方法    选取2017年1月至2019年1月青海省人民医院收治的老年髋部骨折手术患者140例，完全随机分为对照组和观察组，各70例。对照组患者给予丙泊酚静脉麻醉，观察组患者在对照组基础上复合局部浸润麻醉。比较2组患者的痛觉阻滞起效时间和痛觉阻滞持续时间以及术前及术后4周蒙特利尔认知评估量表（MoCA）、简易智力状态检查量表（MMSE）、抑郁自评量表（SDS）评分，并采用酶联免疫吸附测定法检测患者血清中神经元特异性烯醇化酶（NSE）、中枢神经特异性蛋白(S100β)、β-淀粉样蛋白（Aβ）、C反应蛋白（CRP）及白细胞介素（IL-1β）水平变化。结果    观察组患者的痛觉阻滞起效时间明显短于对照组，痛觉阻滞持续时间明显长于对照组［（40±7）s比（67±9）s、（499±33）min比（314±24）min］，差异均有统计学意义（均P＜0.05）。手术前后2组间MoCA评分、MMSE评分、SDS评分和血清NSE、S100β、Aβ、CRP及IL-1β水平比较，差异均无统计学意义（均P＞0.05）。2组患者术后MoCA评分和MMSE评分均明显低于术前，而SDS评分和血清NSE、S100β、Aβ、CRP及IL-1β水平均明显高于术前，差异均有统计学意义（均 P＜0.05）。结论    局部浸润联合丙泊酚静脉麻醉对老年髋部骨折手术患者痛觉阻滞效果好且不降低患者的认知功能评分。

• 【Abstract】Objective    To observe the effect of local infiltration anesthesia combined with propofol intravenous anesthesia on cognitive function in elderly patients undergoing hip fracture surgery. Methods    Totally 140 elderly patients undergoing hip fracture surgery in Qinghai Provincial People′s Hospital from January 2017 to January 2019 were randomly divided into control group and observation group, with 70 cases in each group. The control group had propofol intravenous anesthesia; the observation group had local infiltration combined with propofol intravenous anesthesia. Onset time and duration time of pain block were observed. Scores of Montreal Cognitive Assessment Scale(MoCA), Mini-Mental State Examination(MMSE) and Self-Rating Depression Scale(SDS) were recorded before and 4 weeks after operation. Serum levels of neuron specific enolase(NSE), central neuron specific protein(S100β), β-amyloid protein(Aβ), C-reactive protein(CRP) and interleukin-1β(IL-1β) were tested by enzyme-linked immunosorbent assay. Results    Onset time of pain block in observation group was significantly shorter while duration time of pain block was significantly longer than those in control group［（40±7）s vs （67±9）s, （499±33）min vs （314±24）min］（both P＜0.05）. There were no significant differences of MoCA score, MMSE score, SDS score, serum NSE, S100β, Aβ, CRP and IL-1β levels between groups before and after operation(all P＞0.05). At 4 weeks after operation, MoCA score and MMSE score significantly decreased and SDS score, serum NSE, S100β, Aβ, CRP and IL-1β levels significantly increased compared to those before operation in both groups(all P＜0.05). Conclusion    Local infiltration combined with propofol intravenous anesthesia shows a good pain block effect on elderly patients undergoing hip fracture surgery without impairing the cognitive function.