超声引导下星状神经节阻滞预防老年髋部骨折术后认知功能障碍的研究

王斌宏; 秦金玲

doi:10.16766/j.cnki.issn.1674-4152.003245

超声引导下星状神经节阻滞预防老年髋部骨折术后认知功能障碍的研究

doi: 10.16766/j.cnki.issn.1674-4152.003245

王斌宏^1, ,,
秦金玲²

1.
绍兴文理学院附属新昌医院麻醉科，浙江绍兴 312500
2.
宁波市第二人民医院麻醉科，浙江宁波 315000

基金项目:

浙江省医药卫生科技计划项目 2018ZH028

详细信息

通讯作者:
王斌宏，E-mail: wangys679@163.com

中图分类号: R614.4R683.3
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- 文章访问数: 166
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- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-20
- 网络出版日期: 2024-01-13

Study on the effect of ultrasound-guided stellate ganglion block for preventing cognitive impairment after hip fracture surgery in the elderly

WANG Binhong^{1
, ,},
QIN Jinling²

1.
Department of Anesthesiology, Xinchang Hospital Affiliated to Shaoxing University of Arts and Sciences, Shaoxing, Zhejiang 312500, China

摘要

摘要: 目的老年患者出现术后认知功能障碍(POCD)风险较高，本研究探讨超声引导下星状神经节阻滞(SGB)对老年髋部骨折手术后认知功能的改善作用，以提高患者预后。方法选取2019年5月—2023年5月绍兴文理学院附属新昌医院收治的170例老年髋部骨折手术患者，采用随机数表法分为对照组(85例)和研究组(85例)，对照组实施全麻条件下全髋关节置换术，研究组于麻醉诱导前增加超声引导下SGB。记录手术及麻醉恢复指标，监测麻醉过程中血流动力学指标变化，分析脑氧代谢和脑损伤生化指标，统计术后3 d的POCD发生情况。结果 2组术中出血量、手术时长、术后苏醒时间和拔管时间比较差异均无统计学意义(均P＞0.05)。2组切皮时和手术进行60 min时心率、平均动脉压均低于入室后(均P＜0.001)。研究组术毕即刻脑氧摄取率[(28.93±2.79)%]低于对照组[(31.29±2.56)%]，而脑静脉氧含量、脑氧饱和度和脑血流量/脑氧代谢率[(110.78±5.66)mL/L，(61.94±3.78)min，16.22±1.16]均高于对照组[(104.39±5.92)mL/L，(57.62±3.64)min，15.09±1.03，均P＜0.001]。研究组术后3 d血浆S-100β蛋白和神经元特异性烯醇化酶均低于对照组(均P＜0.001)。研究组术后3 d的POCD发生率(8.24%，7/85)低于对照组(22.35%，19/85，χ²=6.538，P=0.011)。结论超声引导下SGB可改善老年髋部骨折手术患者脑组织血氧供给及代谢功能，缓解脑损伤，降低POCD的发生风险。
- 超声 /
- 星状神经节阻滞 /
- 老年 /
- 髋部骨折 /
- 术后认知功能障碍 /
- 预防
Abstract: Objective Elderly patients have a higher risk of postoperative cognitive dysfunction (POCD), and this study investigates the improvement effect of ultrasound-guided stellate ganglion block (SGB) on cognitive function after hip fracture surgery in the elderly in order to improve the patient's prognosis. Methods A total of 170 elderly patients who underwent hip fracture surgery at Xinchang Hospital Affiliated to Shaoxing University of Arts and Sciences from May 2019 to May 2023 were randomly divided to a control group (85 cases) and a study group (85 cases) by random number table method. The control group underwent total hip replacement surgery under general anesthesia, and the study group received ultrasound guided SGB intervention before anesthesia induction. The surgical and anesthesia recovery indicators were recorded. The changes in hemodynamic indicators during anesthesia were monitored. The brain oxygen metabolism indicators and brain injury biochemical indicators were analyzed, and the occurrence of POCD 3 days after surgery were calculated. Results There was no statistically significant difference in intraoperative bleeding volume, surgical duration, postoperative recovery time, and extubation time between the two groups (all P > 0.05). The heart rate (HR), mean arterial pressure (MAP) values during skin incision and 60 minutes after surgery in both groups were significantly lower than those after admission (all P < 0.001). Immediately after surgery, the cerebral oxygen uptake rate values in the study group [(28.93±2.79)%] were significantly lower than that in the control group [(31.29±2.56)%], while the cerebral venous oxygen content, regional cerebral oxygen saturation and cerebral blood flow/cerebral metabolic rate of oxygen values [(110.78±5.66) mL/L, (61.94±3.78) min, 16.22±1.16] were significantly higher than those in the control group [(104.39±5.92) mL/L, (57.62±3.64) min, 15.09±1.03, all P < 0.001]. The content of serum S-100β and neuron specific enolase at 3 days after surgery in the study group were significantly lower than the control group (all P < 0.001). The incidence of POCD at 3 days after surgery in the study group (8.24%, 7/85) was significantly lower than that in the control group (22.35%, 19/85, χ²=6.538, P=0.011). Conclusion Ultrasound guided SGB can improve brain tissue oxygen supply and metabolic function in elderly patients undergoing hip fracture surgery, alleviate brain injury, and reduce the risk of POCD.
- Ultrasound /
- Stellate ganglion block /
- Elderly /
- Hip fracture /
- Postoperative cognitive dysfunction /
- Prevention

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表 1 2组髋部骨折手术患者手术及麻醉恢复指标比较(x±s)

Table 1. Comparison of recovery indicators of operation and anesthesia between two groups of hip fracture patients (x±s)

组别	例数	术中出血量(mL)	手术时长(min)	苏醒时间(min)	拔管时间(min)
对照组	85	159.89±6.74	114.63±7.19	11.69±1.36	15.03±1.41
研究组	85	161.42±6.85	115.39±7.28	11.43±1.27	14.86±1.49
t值		1.467	0.684	1.288	0.764
P值		0.144	0.494	0.199	0.446

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表 2 2组髋部骨折手术患者不同麻醉时点血流动力学指标比较(x±s)

Table 2. Comparison of hemodynamic indicators between two groups of hip fracture patients at different anesthesia time points (x±s)

组别	例数	HR(次/min)
组别	例数	T1	T2	T3	T4	T5
对照组	85	83.49±5.86	71.94±5.76^a	78.51±5.83^a	82.74±5.59	83.06±5.87
研究组	85	84.02±6.13	72.67±5.94^a	79.26±5.66^a	83.15±5.47	83.65±5.49
t值		0.493	0.512	0.603	0.463	0.548
P值		0.569	0.547	0.452	0.592	0.514

组别	例数	MAP(mmHg)
组别	例数	T1	T2	T3	T4	T5
对照组	85	98.57±7.62	81.94±8.14^a	91.35±8.04^a	95.78±7.73	97.42±7.93
研究组	85	98.29±7.31	82.46±8.36^a	92.13±8.45^a	96.45±7.62	97.84±7.52
t值		0.358	0.407	0.524	0.453	0.396
P值		0.697	0.649	0.537	0.612	0.669

组别	例数	SPO₂(%)
组别	例数	T1	T2	T3	T4	T5
对照组	85	97.36±0.96	96.84±1.04	97.21±0.96	97.04±1.03	97.49±0.97
研究组	85	97.05±1.06	96.92±0.91	96.85±1.05	97.22±1.12	97.20±1.04
t值		0.613	0.417	0.648	0.463	0.559
P值		0.458	0.651	0.419	0.594	0.506
注：与同组T1时刻比较，^aP＜0.05。

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表 3 2组髋部骨折手术患者脑氧代谢指标比较(x±s)

Table 3. Comparison of brain oxygen metabolism indicators between two groups of hip fracture patients (x±s)

组别	例数	CjvO₂(mL/L)		rSO₂(%)		CERO₂(%)		CBF/CMRO₂
组别	例数	入室后	术毕即刻	入室后	术毕即刻	入室后	术毕即刻	入室后	术毕即刻
对照组	85	112.45±5.74	104.39±5.92^a	64.18±3.59	57.62±3.64^a	27.54±2.63	31.29±2.56^a	17.23±1.14	15.09±1.03^a
研究组	85	112.06±5.52	110.78±5.66	64.52±3.93	61.94±3.78	27.17±2.48	28.93±2.79	16.95±1.08	16.22±1.16
t值		0.452	7.193	0.588	7.589	0.944	5.396	1.644	6.716
P值		0.662	＜0.001	0.557	＜0.001	0.347	＜0.001	0.102	＜0.001
注：与同组入室后比较，^aP＜0.05。

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表 4 2组髋部骨折手术患者脑损伤生化指标比较(x±s)

Table 4. Comparison of biochemical indicators of brain injury between two groups of hip fracture patients (x±s)

组别	例数	S-100β(μg/L)		NSE(ng/mL)
组别	例数	入室后	术后3 d	入室后	术后3 d
对照组	85	0.26±0.08	0.43±0.11^a	3.62±0.59	4.92±0.78^a
研究组	85	0.27±0.09	0.31±0.09	3.54±0.62	3.81±0.64
t值		0.766	7.784	0.862	10.682
P值		0.445	＜0.001	0.390	＜0.001
注：与同组入室后比较，^aP＜0.05。

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