摘要
目的:研究区域神经阻滞联合全身麻醉对胫腓骨骨折手术患者应激反应、认知功能及睡眠质量的影响。方法:选取2020年1月至2022年9月在郑州大学第一附属医院行切开复位内固定术的胫腓骨骨折患者104例,根据麻醉方式分为观察组(区域神经阻滞联合全身麻醉,64例)和对照组(全身麻醉,40例)。比较2组患者麻醉诱导前、手术切皮时、手术30 min、手术结束时、术后30 min应激反应指标[血清白介素-6(IL-6)、皮质醇(COR)水平],记录苏醒时间,拔管时间,拔管后VAS评分、镇静Ramsay评分,并于术前1 d、术后1 d和3 d评价患者认知功能(MMSE评分)及睡眠质量(PSQI评分)。结果:与对照组比较,观察组血清IL-6、COR水平波动更小(P<0.001)。观察组苏醒时间[(7.11±1.55)min vs(12.28±1.83)min]、拔管时间[(11.09±1.26)d vs(17.43±2.02)d]均短于对照组,且拔管后VAS评分[(1.92±0.70)分vs(3.95±0.71)分]低于对照组(P<0.05)。2组拔管后镇静Ramsay评分差异无统计学意义(P=0.100)。观察组术后MMSE评分、PSQI评分较对照组有更大改善(P<0.001)。结论:区域神经阻滞联合全身麻醉能够减少胫腓骨骨折手术患者应激反应,不损伤术后认知功能,保障术后睡眠质量。
Aim:To study the effects of regional nerve block combined with general anesthesia on stress response,cognitive function and sleep quality in patients undergoing tibia-fibula fracture surgery.Methods:A total of 104 patients with tibia-fibula fracture who accepted open reduction and internal fixation in the First Affiliated Hospital of Zhengzhou University,from January 2020 to September 2022 were selected.The patients were allocated into observation group(64 cases,regional nerve block combined with general anesthesia)and control group(40 cases,general anesthesia).Stress response indexes[serum interleukin-6(IL-6),cortisol(COR)levels]before induction,at incision,at 30 min operation,at the end of surgery,and 30 min after surgery,as well as recovery time,extubation time,VAS score and Ramsay score after extubation were compared between the 2 groups.Cognitive function(MMSE score)and sleep quality(PSQI score)on 1 day before surgery,and 1 day and 3 days after surgery were compared between the 2 groups.Results:Compared with control group,the changes of serum IL-6 and COR levels in the observation group were smaller(P<0.001),the recovery time[(7.11±1.55)min vs(12.28±1.83)min]and extubation time[(11.09±1.26)days vs(17.43±2.02)days]of the observation group were shorter,and the VAS score after extubation[(1.92±0.70)vs(3.95±0.71)]was lower(P<0.05).The Ramsay score of the 2 groups had no significant difference(P=0.100).After surgery,MMSE score and PSQI score in the observation group had much improvement compared with control group(P<0.001).Conclusion:Regional nerve block combined with general anesthesia could reduce stress response,does not impair postoperative cognitive ability,and guarantee postoperative sleep quality in patients accepting tibia-fibula fracture surgery.
作者
周立君
张伟
张璐
刘蕊
任小栋
尚学栋
曹路
邢飞
ZHOU Lijun;ZHANG Wei;ZHANG Lu;LIU Rui;REN Xiaodong;SHANG Xuedong;CAO Lu;XING Fei(Department of Anesthesiology,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)
出处
《郑州大学学报（医学版）》
CAS
北大核心
2024年第1期83-87,共5页
Journal of Zhengzhou University(Medical Sciences)
基金
国家自然科学基金青年基金项目(82001187)。
关键词
区域神经阻滞
胫腓骨骨折
应激反应
认知功能
睡眠质量
regional nerve block technique
tibia-fibula fracture
stress response
cognitive function
sleep quality
