2022 年第 11 期 第 17 卷

不同浓度罗哌卡因髂筋膜间隙阻滞对全髋关节置换术患者认知功能的影响

Effects of different concentrations of ropivacaine for fascia iliaca compartment block on cognitive function in patients with total knee arthroplasty

作者：冯腾尘姚杰王佳奕孙晓佳赵继波李福龙

英文作者：Feng Tengchen Yao Jie Wang Jiayi Sun Xiaojia Zhao Jibo Li Fulong

单位：河北北方学院附属第一医院麻醉科，张家口075000

英文单位：Department of Anesthesiology the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China

关键词：全髋关节置换术；罗哌卡因；髂筋膜间隙阻滞；认知功能障碍；β淀粉样蛋白

英文关键词：Totalkneearthroplasty;Ropivacaine;Fasciailiacacompartmentblock;Cognitivedysfunction;β-amyloidprotein

• 摘要：

• 目的 探讨不同浓度罗哌卡因髂筋膜间隙阻滞对全髋关节置换术（TKA）患者认知功能的影响。方法 选取2019年1月至2021年12月于河北北方学院附属第一医院择期行TKA治疗的180例髋关节骨折患者作为研究对象。按照罗哌卡因不同使用浓度分为低浓度（0.2%）、中浓度（0.3%）和高浓度（0.4%）组，每组60例。均在全身麻醉下行TKA，术后高浓度组予髂筋膜间隙置管行0.4%罗哌卡因镇痛泵镇痛、中浓度组行0.3%罗哌卡因镇痛泵镇痛、低浓度组行0.2%罗哌卡因镇痛泵镇痛，观察记录患者主要观察指标术后认知功能以及次要观察指标手术时间、术后酮咯酸氨丁三醇用量、术后疼痛程度、炎症因子水平、不良反应发生情况。结果 3组患者简易智力状态检查量表（MMSE）评分以及疼痛视觉模拟量表（VAS）评分时点间与组间存在交互作用（P＜0.05），高浓度组与中浓度组MMSE评分明显高于低浓度组［术后1 d：（26.7±0.8）、（26.1±0.7）分比（24.5±0.7）分；术后3 d：（27.8±0.8）、（27.4±0.8）分比（26.7±0.8）分］（均P＜0.05）；术后1 d高浓度组MMSE评分明显高于中浓度组（P＜0.05）。术后12、24、48 h的VAS评分均逐渐降低（P＜0.05），且高浓度组VAS评分明显低于中浓度组与低浓度组（均P＜0.05）。3组患者血清β淀粉样蛋白（Aβ）、肿瘤坏死因子α（TNF-α）、白细胞介素1β（IL-1β）、IL-6水平时点间与组间存在交互作用（均P＜0.05），且术后1、3 d高浓度组血清Aβ、TNF-α、IL-1β、IL-6明显低于中浓度组与低浓度组（均P＜0.05）。高浓度组与中浓度组不良反应发生率均低于低浓度组，差异均有统计学意义（均P＜0.05）。结论 0.4%的罗哌卡因更利于促进TKA患者认知功能恢复，利于术后镇痛以及炎症反应消退，促进应用效果更佳。

• Objective To investigate the effects of different concentrations of ropivacaine for fascia iliaca compartment block on cognitive function in patients with total knee arthroplasty(TKA). Methods Totally 180 patients with hip fracture undergoing elective TKA in the First Affiliated Hospital of Hebei North University from January 2019 to December 2021 were selected as the research subjects. Patients were divided into low concentration group(0.2%), medium concentration group(0.3%) and high concentration group(0.4%) according to different concentrations of ropivacaine, with 60 cases in each group. During the operation, TKA was performed under general anesthesia. Postoperative analgesia was performed with 0.4%/0.3%/0.2% ropivacaine analgesia pump injected into fascia iliaca compartment in the high/medium/low concentration groups, respectively. The main indicator of postoperative cognitive function and the secondary indicators such as operative time, postoperative ketorolac tromethamine dosage, degree of postoperative pain, levels of inflammatory factors, adverse reactions were observed and recorded. Results There was an interaction in Mini-Mental State Examimation(MMSE) score and pain visual analog scale(VAS) score among time points and groups(P＜0.05), MMSE score in high concentration group and medium concentration group was significantly higher than that in low concentration group［day 1 after operation:（26.7±0.8）,（26.1±0.7） vs （24.5±0.7）; day 3 after operation:（27.8±0.8）,（27.4±0.8） vs （26.7±0.8）］(all P＜0.05); the MMSE score of high concentration group was significantly higher than that of medium concentration group day 1 after operation(P＜0.05); and VAS scores of 12, 24 and 48 h after surgery gradually decreased(P＜0.05). The VAS score of high concentration group was significantly lower than that of medium concentration group and low concentration group(both P＜0.05). The levels of serum β amyloid protein(Aβ), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), IL-6 had interaction among time points and groups(all P＜0.05). Serum levels of Aβ, TNF-α, IL-1β and IL-6 in high concentration group were significantly lower than those in medium concentration group and low concentration group on day 1 and 3 after operation(all P＜0.05). The incidence of adverse reactions in high concentration group and medium concentration group was lower than that in low concentration group(all P<0.05). Conclusion It is more beneficial to promoting cognitive function recovery, postoperative analgesia and inflammatory response regression by  0.4% ropivacaine which has better application effect in patients with TKA.