2025 年第 2 期 第 20 卷

超声引导下神经阻滞联合七氟醚喉罩全身麻醉对老年髋部骨折患者围手术期应激及术后谵妄发生的影响

Influence of ultrasound guided nerve block combined with sevoflurane laryngeal mask general anesthesia on perioperative stress and occurrence of postoperative delirium in elderly patients with hip fractures

作者：白文娟1岳惠玉2党莎杰2

英文作者：Bai Wenjuan1 Yue Huiyu2 Dang Shajie2

单位：1延安大学附属医院麻醉科，延安716000；2陕西省肿瘤医院麻醉科，西安710043

英文单位：1Department of Anesthesiology Yan′an University Affiliated Hospital Yan′an 716000 China; 2Department of Anesthesiology Shaanxi Provincial Cancer Hospital Xi′an 710043 China

关键词：超声引导下外周神经阻滞；七氟醚；老年髋部骨折；应激；谵妄

英文关键词：Ultrasoundguidedperipheralnerveblock;Sevoflurane;Elderlyhipfractures;Stress;Delirium

• 摘要：

• 目的 探究超声引导下外周神经阻滞联合七氟醚喉罩全身麻醉对老年髋部骨折患者围手术期应激及术后谵妄发生的影响。方法 前瞻性选取延安大学附属医院2020年1月至2023年6月收治的老年髋部骨折患者266例，采用信封法分为A组、B组，各133例。A组给予喉罩通气七氟醚吸入全身麻醉，B组给予超声引导下周围神经阻滞联合七氟醚喉罩全身麻醉。比较2组术前5 min及术后2、12、24 h应激指标［皮质醇、超氧化物歧化酶（SOD）、血管紧张素Ⅱ（Ang-Ⅱ）］水平和视觉模拟量表（VAS）评分变化情况，术后第1、2、3天简易精神状态检查量表（MMSE）评分及谵妄发生情况。记录患者围手术期不良反应发生情况。结果 术后2、12、24 h，2组皮质醇、Ang-Ⅱ及SOD水平均高于术前5 min，但B组各时点均低于A组（均P＜0.05）；术后2、12、24 h，2组VAS评分均低于术前5 min，且B组各时点VAS评分均低于A组（均P＜0.05）；B组术后第1、2、3天MMSE评分均高于A组［（20±5）分比（18±4）分、（21±5）分比（19±4）分、（24±4）分比（21±5）分］，谵妄发生率均低于A组（均P<0.05）。B组术中低血压、苏醒期躁动、呼吸抑制发生率均低于A组（均P<0.05）。结论 超声引导下外周神经阻滞联合七氟醚喉罩全身麻醉更有利于减轻老年髋部骨折患者术后应激和疼痛，同时对降低术后谵妄、术中低血压及苏醒期躁动等发生率有积极意义。

• Objective To explore the influence of ultrasound guided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia on perioperative stress and occurrence of postoperative delirium in elderly patients with hip fractures. Methods A total of 266 elderly patients with hip fracture admitted to Yan′an University Affiliated Hospital from January 2020 to June 2023 were prospectively selected and divided into group A and group B by envelope method, with 133 cases in each group. Group A was given laryngeal mask ventilation and sevoflurane inhalation general anesthesia, while group B was given ultrasoundguided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia. The changes in stress indicators levels ［cortisol, superoxide dismutase (SOD), angiotensin-Ⅱ (Ang-Ⅱ)］ and visual analogue scale (VAS) scores at 5 min before operation and 2, 12, 24 h after operation, and Mini-Mental State Examination (MMSE) score and delirium occurrence on the 1st, 2nd and 3rd day after operation were compared between the two groups. The occurrence of perioperative adverse reactions was recorded.Results The levels of cortisol, Ang-Ⅱ and SOD at 2, 12 and 24 h after operation in both groups were higher than those at 5 min before operation but the levels in group B were lower than those in group A in each time point (all P<0.05). At 2, 12 and 24 h after operation, the VAS scores of the two groups were lower than those at 5 min before operation, and the VAS scores of group B were lower than those of group A at each time point (all P<0.05). The MMSE scores of group B were higher than those of group A on the 1st, 2nd and 3rd day after operation［（20±5） vs （18±4）,（21±5） vs （19±4）,（24±4） vs （21±5）］, and the incidences of delirium were lower than those of group A (all P<0.05). The incidences of intraoperative hypotension, restlessness during recovery and respiratory depression in group B were lower than those in group A(all P<0.05). Conclusion Ultrasoundguided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia is more conducive to reducing postoperative stress and pain in elderly patients with hip fracture, and has positive significance in reducing the incidence of postoperative delirium, intraoperative hypotension and restlessness during recovery.