目的 探讨右美托咪定联合超声引导下腰骶丛神经阻滞在老年髋关节置换术中的应用效果。方法 选取80例接受髋关节置换术的老年患者,分为Ⅰ、Ⅱ组。Ⅰ组给予全身麻醉,Ⅱ组行超声引导下的腰骶丛神经阻滞复合静脉麻醉。比较两组患者术后48 h的VAS评分,检测各时间点S100-β蛋白和神经元特异性烯醇化酶(NSE)浓度,观察术后7 d谵妄(POD)发生情况。结果 术后2 h、6 h、12 h、24 h和36 h时,Ⅱ组VAS评分明显低于Ⅰ组(P<0.05);术后各时间点Ⅱ组S100-β及NSE的浓度明显低于Ⅰ组(P<0.05)。术后Ⅱ组POD发生率明显低于Ⅰ组(P<0.05)。结论 右美托咪定联合超声引导下腰骶丛神经阻滞用于老年患者髋关节置换术,镇痛效果好,可改善术后认知功能,值得推广应用。

Objective To investigate the effect of preoperative intravenous infusion of dexmedetomidine combined with ultrasound-guided lumbosacral plexus block in elderly patients undergoing hip replacement surgery.Methods Eighty elderly patients with hip fracture were treated with hip replacement surgery.They were divided into 2 groups:groupⅠand groupⅡ.Patients in groupⅠreceived general anesthesia,and patients in groupⅡreceived venous anesthesia combined with ultrasound-guided lumbosacral plexus block.The VAS scores of the two groups in 48 hours after surgery,the expression of S100-βand NSE,and the incidence of POD within 7 days after surgery were observed.Results The VAS scores of groupⅡwere significantly lower than those of groupⅠat 2,6,12,24 and 36hours after operation(P<0.05).The expressions of S100-βand NSE in groupⅡwere significantly lower than those in groupⅠat each time point after operation(P<0.05).The incidence rate of POD in groupⅡwas significantly lower than that in groupⅠ(P<0.05).Conclusion Dexmedetomidine combined with ultrasound-guided lumbosacral plexus block used in elderly patients undergoing hip arthroplasty has good analgesic effect and improved postoperative cognitive function,which is worthy of clinical promotion and application.