连续腰丛阻滞降低老年患者髋关节置换术后早期认知功能障碍的发生

目的：观察连续腰丛阻滞(continuous lumbar plexus block，CLPB)对老年患者髋关节置换术后认知功能障碍(post-operative cognitive dysfunction，POCD)的影响。方法：选择在全身麻醉下行髋关节置换手术老年患者60例，随机分为连续腰丛阻滞(continuous lumbar plexus block，CLPB)组和静脉自控镇痛(patient-controlled intravenous analgesia，PCIA)组，每组30例。所有患者在全身麻醉下完成手术，CPLB组气管插管前行腰丛阻滞，术后行CLPB镇痛；PCIA组术后行PCIA。记录术后12，24及48 h视觉模拟评分(Visual Analog Scale，VAS)；于术前1 d(D0)以及术后1(D1)，3(D3)，7(D7) d采用简易精神状态量表(Mini-Mental State Examination，MMSE)进行认知功能评分并记录POCD发生情况；D0，D1，D3及D7时采用ELISA法检测血清S-100β浓度；记录术后不良反应的发生情况。结果：CLPB组术后12，24及48 hVAS评分明显低与PCIA组(P<0.05)；与PCIA组相比，CLPB组于D1，D3时MMSE评分明显增高(P<0.05)，POCD的发生率降低(P<0.05)。CLPB组D1，D3时组S-100β浓度明显低于PCIA组(P<0.05)。结论：CLPB应用于老年患者髋关节置换术，可有效缓解患者术后疼痛，抑制S-100β的产生，降低早期POCD的发生。

Continuous lumbar plexus block reduces the incidence of early postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty

Objective: To observe the impacts of continuous lumbar plexus block (CLPB) on postoperativecognitive dysfunction (POCD) in elderly patients undergoing hip arthroplasty.Methods: Sixty elderly patients scheduled for hip arthroplasty with general anesthesia, wererandomly allocated into a CLPB group and a PCIA group (n=30 each). In the CLPB group, lumbarplexus block was performed before trachea intubation, and CLPB was used for postoperativeanalgesia. In the PCIA group, intravenous analgesia was controlled in patients after operation.Visual Analogue Scale (VAS) at 12, 24, and 48 h after operation was recorded. Mini-MentalState Examination (MMSE) scale was used to evaluate the cognitive dysfunction at the 1st daybefore operation (D0) and at the 1st (D1), 3rd (D3), and 7th (D7) days after operation and theoccurrence of POCD was recorded. S-100β concentrations were detected by ELISA at D1, D3, andD7. Postoperative adverse events were recorded.Results: VAS scores at 12, 24, and 48 h after operation in the CLPB group were significantly lowerthan those in the PCIA group (P<0.05). Compared with the PCIA group, the MMSE scores weresignificantly higher (P<0.05), and the incidence of POCD at D1 and D3 was obviously reduced inthe CLPB group (P<0.05). S-100β concentration at D1 and D3 in the CLPB group was significantlylower than that in the PCIA group (P<0.05).Conclusion: Application of CLPB in elderly patients undergoing hip arthroplasty could obviouslyrelieve their postoperative pain, inhibit the production of S-100β, and reduce the incidence of earlypostoperative cognitive dysfunction.