观察星状神经节阻滞对抑制髋关节置换术后老年早期术后认知功能障碍的影响.doc

观察星状神经节阻滞对抑制髋关节置换术后老年早期术后认知功能障碍的影响

摘要目的评价星状神经节阻滞（stellateganglionblock，SGB）对髋关节置换术所导致的老年早期术后认知功能障碍（postoperativecognitivedysfunction，POCD）影响。方法收集2014年10月至2017年3月在菏泽市成武县人民医院行髋关节置换术的老年患者100例。所有患者均在术前行硬膜外麻醉。根据患者是否在麻醉前接受SGB注射将其分成对照组和SGB组。记录并检测两组患者的临床表征、POCD发生率、和血清中炎症细胞因子浓度。结果髋关节置换术导致两组患者最小精神状态检查评分（Mini-mentalstatusexam,MMSE）出现先下降（术后第1、3天）后回升（术后第7天）的趋势。与对照组相比，SGB组在术后第1、3天的MMSE评分显著升高（P0.05），而POCD发生率明显降低（P0.05）。术后第3天，对照组的炎症细胞因子水平(IL-1、IL-6和TNF-α)明显高于SGB组（P0.05）。结论SGB的临床使用可以有效抑制老年患者在髋关节置换术后发生POCD。

关键词老年；星状神经节阻滞；早期认知障碍；炎症细胞因子

Effectofstellateganglionblockoncognitivedysfunctioninelderlypatientswithpostoperativehipreplacement

AbstractObjectiveToevaluatetheclinictherapeuticeffectofSGBontheearlyPOCDcausedbyhiparthroplastyintheelderpatients.MethodsFromOctober2014toMarch2017,onehundredelderpatientswithhipreplacementunderepiduralanesthesiainChengwuTownPeoplesHospitalofHezeCitywereenrolledinthisstudy.TheyweredividedintothecontrolandSGBgroupsaccordingtowhetherthepatientsreceivedSGBbeforeanesthesia.Thecliniccharacterization,incidenceofPOCD,andserumlevelsofpro-inflammatorycytokinesweremeasuredandexaminedforallpatients.ResultsHiparthroplastyledtoadecreaseinMMSEscoresofthetwogroupsonday1andday3,butatrendofrecoveryattheday7.Comparedwiththecontrolgroup,theMMSEscoresoftheSGBgrouponthe1stand3rdpostoperativedayweresignificantlyhigher(P0.05),butthePOCDincidencewassignificantlylower(P0.05).Onthethirddayafteroperation,thelevelsofinflammatorycytokines(IL-1,IL-6andTNF-α)inthecontrolgroupweresignificantlyhigherthanthoseintheSGBgroup(P0.05).ConclusionTheclinicaluseofSGBcaneffectivelyinhibitPOCDinelderlypatientsafterhipjointreplacement.

Keywordseldly;stellateganglionblock;postoperativecognitivedysfunction;pro-inflammatorycytokines

术后认知功能障碍（postoper