Wang Xiuzhen, Ge Yeying
Department of Anesthesiology, Ningbo No. 6 Hospital Zhongshan East Road, Ningbo 315040, Zhejiang, China.
Am J Transl Res. 2022 Jun 15;14(6):3915-3925. eCollection 2022.
To investigate the influence of nerve block combined with general anesthesia on the cognitive function and postoperative pain of patients undergoing knee joint replacement and analyze the risk factors of postoperative cognitive dysfunction.
A retrospective analysis was conducted on 104 elderly patients undergoing knee joint replacement in our hospital between January 2018 and January 2021. The control group (n=50) received laryngeal mask anesthesia, while the observation group (n=54) received ultrasound-guided nerve block combined with laryngeal mask anesthesia. The visual analogue scale (VAS) was adopted for scoring the pain intensity of both groups, and the Mini-Mental State Examination (MMSE) was used for evaluating changes in cognitive function before and after operation. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were adopted for scoring patientsbefore and after operation. Additionally, the time to spontaneous breathing recovery, time to wake up, time to open eyes when ordered, and extubation time of the two groups were recorded. The changes in serum IL-6, cortisol (Cor), and IL-10 before and after operation were compared. The two groups were compared in the dosage of used analgesic drugs, the first getting out-of-bed time, treatment expense, and hospitalization time. The correlation between VAS score and IL-6, Cor and IL-10 before and after treatment was analyzed. The adverse reactions of the two groups were also compared. Logistic regression was used to analyze risk factors for cognitive dysfunction.
After operation, the observation group experienced shorter spontaneous breathing recovery time, time to wake up, time to open eyes when ordered, and extubation time, than the control group (P<0.05). The observation group also consumed less sufentanil than the control group (P<0.05). Additionally, the observation group had lower VAS and MMSE scores than the control group at 6 and 12 h after operation (P>0.05) and lower SAS and SDS scores than the control group (P<0.05). Moreover, at 6 h after operation, the control group showed higher levels of IL-6, Cor and IL-10 than the observation group (P<0.05), and the control group experienced later first getting out-of-bed time and a longer hospitalization time than the observation group (P<0.05). There was a positive correlation between VAS score and IL-6 as well as Cor before and after treatment (P<0.05). The two groups were similar in treatment expense (P>0.05) and the incidence of adverse reactions (P>0.05). Age and anesthesia scheme were risk factors for postoperative cognitive dysfunction.
Nerve block combined with general anesthesia can effectively improve the cognitive function and analgesic effect of elderly patients undergoing knee joint replacement, and accelerate recovery time, without increasing f adverse reactions, and can also accelerate recovery of their cognitive function.
探讨神经阻滞联合全身麻醉对膝关节置换患者认知功能及术后疼痛的影响，并分析术后认知功能障碍的危险因素。
回顾性分析2018年1月至2021年1月在我院行膝关节置换术的104例老年患者。对照组（n=50）采用喉罩麻醉，观察组（n=54）采用超声引导下神经阻滞联合喉罩麻醉。采用视觉模拟评分法（VAS）对两组患者的疼痛强度进行评分，采用简易精神状态检查表（MMSE）评估手术前后认知功能的变化。采用自评焦虑量表（SAS）和自评抑郁量表（SDS）对患者手术前后进行评分。此外，记录两组患者自主呼吸恢复时间、苏醒时间、指令睁眼时间和拔管时间。比较两组患者手术前后血清白细胞介素-6（IL-6）、皮质醇（Cor）和白细胞介素-10的变化。比较两组患者使用镇痛药物的剂量、首次下床时间、治疗费用和住院时间。分析治疗前后VAS评分与IL-6、Cor和IL-10的相关性。比较两组患者的不良反应。采用Logistic回归分析认知功能障碍的危险因素。
术后，观察组自主呼吸恢复时间、苏醒时间、指令睁眼时间和拔管时间均短于对照组（P<0.05）。观察组舒芬太尼用量也少于对照组（P<0.05）。此外，观察组术后6 h和12 h的VAS和MMSE评分低于对照组（P>0.05），SAS和SDS评分低于对照组（P<0.05）。而且，术后6 h，对照组IL-6、Cor和IL-10水平高于观察组（P<0.05），对照组首次下床时间晚于观察组，住院时间长于观察组（P<0.05）。治疗前后VAS评分与IL-6以及Cor呈正相关（P<0.05）。两组患者治疗费用（P>0.05）和不良反应发生率（P>0.05）相似。年龄和麻醉方案是术后认知功能障碍的危险因素。
神经阻滞联合全身麻醉可有效改善老年膝关节置换患者的认知功能和镇痛效果，加快恢复时间，不增加不良反应，还可促进其认知功能恢复。
