摘要
目的观察纳布啡联合股神经阻滞对高龄膝关节置换患者术后镇痛的效果及对认知功能、血清S-100β蛋白的影响。方法选取舟山市中医院2018年3月至2020年3月行膝关节置换术的高龄患者91例,采用随机数字表法分为观察组(n=45)和对照组(n=46)。两组患者均采用股神经阻滞并置管,观察组采用纳布啡进行术后静脉镇痛,对照组患者给予等量0.9%氯化钠注射液。比较两组手术前后简易智力状态检查量表(MMSE)评分、S-100β水平及术后视觉模拟疼痛(VAS)评分、不良反应。结果术前,两组MMSE评分差异无统计学意义(P>0.05),术后3 d,两组MMSE评分均较术前显著降低(均P<0.05),观察组MMSE评分[(25.34±1.31)分]显著高于对照组[(23.67±1.53)分](t=5.34,P<0.05)。术前,两组血清S-100β蛋白差异无统计学意义(P>0.05),术后1 d、3 d,两组血清S-100β蛋白均较术前显著升高(均P<0.05),术后7 d,两组S-100β恢复至术前水平,术后1 d、3 d观察组血清S-100β蛋白均显著低于对照组(t=10.20、9.21,均P<0.05)。观察组术后1 h、3 h、6 h、12 h、24 h的VAS评分分别为(1.14±0.22)分、(1.43±0.25)分、(1.87±0.21)分、(3.56±0.20)分、(2.63±0.23)分,均低于对照组的(2.53±0.24)分、(2.53±0.24)分、(3.56±0.20)分、(3.98±0.25)分、(4.23±0.21)(t=5.10、8.15、9.41、10.18、11.42,均P<0.05)。观察组不良反应发生率为13.33%(6/45),显著低于对照组的30.43%(14/46),差异有统计学意义(χ^(2)=3.88,P=0.049)。结论纳布啡联合股神经阻滞能有效改善高龄膝关节置换患者术后认知功能,并提供良好的术后镇痛,且具有较高的安全性。
Objective To investigate the postoperative analgesic efficacy of nabuprofen combined with femoral nerve block in older adult patients subjected to knee arthroplasty and its effects on cognitive function and serum S-100βprotein level.Methods Ninety-one older adult patients subjected to knee arthroplasty between March 2018 and March 2020 in Zhoushan Hospital of Traditional Chinese Medicine were included in this study.They were randomly divided into observation(n=45)and control(n=46)groups.Patients in both groups received femoral nerve block and catheterization.Naborphine and equal amount of 0.9%sodium chloride injection were intravenously administered in the observation and control groups,respectively for postoperative analgesia.Before and after surgery,Mini-Mental State Examination(MMSE)score,S-100βprotein level and Visual Analogue Scale score,and adverse reactions were compared between the observation and control groups.Results Before surgery,there was no significant difference in MMSE score between the two groups(P>0.05).At 3 days after surgery,MMSE score in each group was significantly decreased compared with before surgery(both P<0.05).At 3 days after surgery,MMSE score in the observation group was significantly higher than that in the control group[(25.34±1.31)points vs.(23.67±1.53)points,t=5.34,P<0.05].Before surgery,there was no significant difference in serum S-100βprotein level between the two groups(P>0.05).At 1 and 3 days after surgery,serum S-100βprotein level in each group was significantly increased compared with before surgery(both P<0.05).At 7 days after surgery,serum S-100βprotein level in each group recovered to pre-operative level.At 1 and 3 days after surgery,serum S-100βprotein level in the observation group was significantly lower than that in the control group(t=10.20,9.21,both P<0.05).At 1,3,6,12 and 24 hours after surgery,the Visual Analogue Scale score in the observation group was(1.14±0.22)points,(1.43±0.25)points,(1.87±0.21)points,(3.56±0.20)points,and(2.63±0.23)points respectively,which was significantly lower than that in the control group[(2.53±0.24)points,(2.53±0.24)points,(3.56±0.20)points,(3.98±0.25)points,(4.23±0.21)points,t=5.10,8.15,9.41,10.18,11.42,all P<0.05].The incidence of adverse reactions in the observation group was significantly lower than that in the control group[13.33%(6/45)vs.30.43%(14/46),χ^(2)=3.88,P=0.049].Conclusion Naborphine combined with femoral nerve block can effectively improve the postoperative cognitive function of older adult patients undergoing knee arthroplasty,provides good postoperative analgesia,and is highly safe.
作者
夏颖
李世文
吴红利
王磊
Xia Ying;Li Shiwen;Wu Hongli;Wang Lei(Department of Anesthesiology,Zhoushan Hospital of Traditional Chinese Medicine,Zhoushan 316000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2021年第11期1691-1695,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
关节成形术
置换
膝
麻醉和镇痛
纳布啡
股神经阻滞
疼痛
手术后
认知
疼痛测定
老年人
Arthroplasty,replacement,knee
Anesthesia and analgesia
Nalbuphine
Femoral nerve block
Pain,postoperative
Cognition
Pain measurement
Aged
作者简介
通信作者:李世文,Email:xiaying8025@163.com,电话:0580-2615064。
