入院时股外侧肌间隙阻滞对老年股骨颈骨折患者术后简易精神状态检查表评分的影响：一项回顾性队列研究
Effect of admission fascia iliaca compartment blocks on post-operative abbreviated mental test scores in elderly fractured neck of femur patients: a retrospective cohort study.
作者信息
Odor Peter M, Chis Ster Irina, Wilkinson Iain, Sage Frederic
机构信息
Perioperative Medicine Fellow, University College London Hospital, London, UK.
Senior Lecturer in Biostatistics, Institute of Infection and Immunity, St. George's University of London, London, UK.
出版信息
BMC Anesthesiol. 2017 Jan 5;17(1):2. doi: 10.1186/s12871-016-0297-8.
BACKGROUND
Post-operative cognitive impairment is common in elderly patients following surgery for hip fracture, with undertreated pain being an important etiological factor. Non-opioid based analgesic techniques, such as nerve blocks, may help reduce the risk of cognitive complications. The aim of this study was to investigate whether receiving a fascia iliaca compartment block (FICB) as part of a pre-operative analgesic regime increased the odds of high post-operative abbreviated mental test scores (AMTS) when compared with conventional analgesia without a nerve block.
METHODS
A retrospective data analysis of a cohort of 959 patients, aged ≥ 65 years with a diagnosis of hip fracture and admitted to a single hospital over a two-year period was performed. A standardized analgesic regime was used on all patients, and 541/959 (56.4%) of included patients received a FICB. Provision of the FICB was primarily determined by availability of an anesthetist, rather than by patient status and condition. Post-operative cognitive ordinal outcomes were defined by AMTS severity as high (score of ≥9/10), moderate, (score of 7-8) and low (score of ≤6). A multivariable ordinal logistic regression analysis was performed on patient status and clinical care factors, including admission AMTS, age, gender, source of admission, time to surgery, type of anesthesia and ASA score.
RESULTS
Admission FICB was associated with higher adjusted odds for a high AMTS (score of ≥9) relative to lower AMTS (score of ≤8) than conventional analgesia only (OR = 1.80, 95% CI 1.27-2.54; p = 0.001). Increasing age, lower AMTS on admission to hospital, and being admitted from a residential or nursing home were associated with worse cognitive outcomes. Mode of anesthesia or surgery did not significantly influence post-operative AMTS.
CONCLUSION
Post-operative AMTS is influenced by pre-operative analgesic regimes in elderly patients with hip fracture. Provision of a FICB to patients on arrival to hospital may improve early post-operative cognitive performance in this population.
背景
术后认知功能障碍在老年髋部骨折手术患者中很常见，疼痛治疗不充分是一个重要的病因。基于非阿片类药物的镇痛技术，如神经阻滞，可能有助于降低认知并发症的风险。本研究的目的是调查与未进行神经阻滞的传统镇痛相比，在术前镇痛方案中接受髂筋膜室阻滞（FICB）是否会增加术后简易精神状态检查表（AMTS）高分的几率。
方法
对一组959例年龄≥65岁、诊断为髋部骨折且在两年内入住同一家医院的患者进行回顾性数据分析。所有患者均采用标准化镇痛方案，纳入的患者中有541/959（56.4%）接受了FICB。FICB的实施主要取决于麻醉师的可用性，而非患者的状态和病情。术后认知序贯结局根据AMTS严重程度定义为高分（≥9/10分）、中度（7 - 8分）和低分（≤6分）。对患者状态和临床护理因素进行多变量序贯逻辑回归分析，包括入院时的AMTS、年龄、性别、入院来源、手术时间、麻醉类型和美国麻醉医师协会（ASA）评分。
结果
与仅采用传统镇痛相比，入院时接受FICB的患者AMTS高分（≥9分）相对于低分（≤8分）的调整后几率更高（比值比[OR]=1.80，95%置信区间[CI] 1.27 - 2.54；p = 0.001）。年龄增加、入院时AMTS较低以及从养老院或护理院入院与较差的认知结局相关。麻醉或手术方式对术后AMTS没有显著影响。
结论
老年髋部骨折患者的术后AMTS受术前镇痛方案的影响。患者入院时给予FICB可能会改善该人群术后早期的认知表现。
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