摘要
目的研究神经阻滞对股骨转子间骨折(IF)老年患者术后心肺并发症的影响,探究神经阻滞及全麻对老年IF患者心肺功能的影响机制。方法2014年1月—2018年12月川北医学院附属医院麻醉科收治IF老年患者98例,男性62例,女性36例;年龄61~80岁,平均67.3岁。采用随机数字表法分为神经阻滞组(n=49)与全身麻醉组(n=49),全身麻醉组行全身麻醉,神经阻滞组行神经阻滞。观察两组麻醉前(t 0)、术中(t 1)、手术结束(t 2)各时间点舒张压(DBP)、收缩压(SBP)、心率(HR)血流动力学指标。术前、术后3d血清5-羟色胺(5-HT)、多巴胺(DA)、去甲肾上腺素(NE)疼痛因子水平,谷胱甘肽过氧化物酶(GSH-PX)、超氧化物歧化酶(SOD)、晚期氧化蛋白产物(AOPP)、丙二醛(MDA)氧化应激因子,术后7d心肺并发症等指标。结果t 1、t 2时,神经阻滞组DBP、SBP、HR均低于全身麻醉组(P<0.05)。术后3d,神经阻滞组5-HT、DA、NE水平低于全身麻醉组[(0.49±0.05)μmol/mL vs.(0.60±0.07)μmol/mL、(16.86±1.74)ng/L vs.(25.45±2.62)ng/L、(1.94±0.21)pg/mL vs.(2.88±0.29)pg/mL,P<0.05]。术后3d,神经阻滞组GSH-PX、SOD高于全身麻醉组[(198.45±19.93)g/mL vs.(163.73±17.74)g/mL、(19.18±2.00)μg/mL vs.(15.63±1.62)μg/mL],AOPP、MDA低于全身麻醉组[(39.57±4.62)μmol/L vs.(50.21±5.27)μmol/L、(16.75±1.74)U/L vs.(21.58±2.23)U/L,P<0.05]。神经阻滞组术后7d心肺并发症(急性冠脉事件、心律失常、肺部感染、呼吸衰竭)发生率(4.08%)低于全身麻醉组(16.33%),P<0.05。结论疼痛因子及氧化应激因子生成、抗氧化应激因子减少是影响老年IF患者心肺功能的重要机制,神经阻滞可有效缓解老年IF患者疼痛,减少机体应激,维持患者血流动力学稳定,改善影响患者心肺功能,避免心肺并发症的发生。
Objective To study the effect of nerve block on cardiopulmonary complications in elderly patients with IF and the effect of nerve block and general anesthesia on cardio-pulmonary function in elderly patients with IF.Methods A total of 98 senile patients with elderly IF surgery admitted to our hospital from Jan.2014 to Dec.2018 were selected as the respondents.They were divided into nerve block group(n=49)and general anesthesia group(n=49)based on the random number table method.Patients in the general anesthesia group were given general anesthesia,while in the nerve block group were given nerve block.The levels of hemodynamic indexes of diastolic blood pressure(DBP),systolic blood pressure(SBP),heart rate(HR)of the two groups at time points of t0(before induction),t1(intraoperative),t2(end of operation),as well as preoperative,postoperative 3d levels of pain factor of serum 5-hydroxytryptamine(5-HT),dopamine(DA),norepinephrine(NE),together with the levels of oxidative stress indexes of glutathione peroxidase(GSH-PX),superoxide dismutase(SOD),late oxidative protein product(AOPP),malondialdehyde(MDA),cardiac and pulmonary complications after operation were observed.Results At t1 and t2,DBP,SBP,HR,SOD and CAT in nerve block group were lower than those in general anesthesia group(P<0.05).At postoperative 3d,5-HT,DA,NE in nerve block group were lower than those in general anesthesia group[(0.49±0.05)μmol/mL vs.(0.60±0.07)μmol/mL,(16.86±1.74)ng/L vs.(25.45±2.62)ng/L,(1.94±0.21)pg/mL vs.(2.88±0.29)pg/mL](P<0.05).At postoperative 3d,GSH-PX,SOD in nerve block group were higher than those in general anesthesia group[(198.45±19.93)μg/mL vs.(163.73±17.74)μg/mL,(19.18±2.00)μg/mL vs.(15.63±1.62)μg/mL],while AOPP,MDA were lower than those in general anesthesia group[(39.57±4.62)μmol/L vs.(50.21±5.27)μmol/L,(16.75±1.74)U/L vs.(21.58±2.23)U/L](P<0.05).At 7d after operation,the incidence of postoperative cardio-pulmonary complications(acute coronary events,arrhythmias,pulmonary infections,respiratory failure)in nerve block group(4.08%)were lower than that in general anesthesia group(16.33%,P<0.05).Conclusion The production of pain factor and oxidative stress factor,and the decrease of antioxidant stress factor are the important mechanisms that affect the cardio-pulmonary function of elderly patients with IF.Nerve block can effectively relieve pain,reduce stress,improve cardio-pulmonary function in patients,maintain hemodynamic stability and avoid cardio-pulmonary complications in elderly patients with IF.
作者
张玉龙
左友波
董碧倩
ZHANG Yu-long;ZUO You-bo;DONG Bi-qian(Department of Anesthesiology,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)
出处
《创伤外科杂志》
2019年第8期611-615,共5页
Journal of Traumatic Surgery
关键词
股骨转子间骨折
神经阻滞
心肺并发症
老年
intertrochanteric fracture
nerve block
cardiopulmonary complications
elderly
