腰丛-坐骨神经阻滞复合七氟烷对老年髋关节置换患者置换后认知功能的影响:前瞻性、单中心、开放性、随机对照临床试验

发布时间：2018-01-20 01:07

本文关键词：组织工程髋关节坐骨神经骨科植入物人工假体髋关节置换腰丛阻滞七氟烷老年认知功能碱性成纤维细胞生长因子简易精神状态量表评分蒙特利尔认知评估量表评分麻醉临床试验　出处：《中国组织工程研究》2017年11期 　论文类型：期刊论文

【摘要】：背景:老年全髋关节置换后患者常并发认知功能障碍,具体机制不清。有研究表明,七氟烷可调节脑内认知功能障相关因子碱性成纤维细胞生长因子的表达,但是否能降低髋关节置换后患者认知功能障的发生尚未见报道。试验假设采用腰丛-坐骨神经阻滞复合七氟烷的麻醉方案,可有效降低老年髋关节置换患者置换后认知功能障碍的发生率。目的:观察采用腰丛-坐骨神经阻滞复合七氟烷的麻醉方案对老年髋关节置换患者置换后认知功能障碍的影响。方法:研究为前瞻性、单中心、开放性、随机对照临床试验,在中国青海省,青海大学附属医院完成。纳入老年单侧全髋关节置换患者70例,随机分为2组,观察组术中以腰丛及坐骨神经阻滞后行气管插管全身麻醉,配合采取吸入七氟烷麻醉维持;对照组术中采取常规气管插管全身麻醉,配合采用静脉给予丙泊酚麻醉维持,置换后1,3 d随访检测患者。试验的主要观察指标为两组患者置换前、置换后1,3 d以简易精神状态量表评分评估患者认知功能;试验的次要观察指标为两组患者置换前、置换后1,3 d以蒙特利尔认知评估量表对患者的评分,血清碱性成纤维细胞生长因子水平;术中失血量及手术时间;其他观察指标为患者术中、置换后1,3 d的不良反应发生率。试验经中国青海省青海大学附属医院伦理委员会批准。研究符合世界医学会制定的《赫尔辛基宣言》的要求。参与者本人对治疗方案和过程均知情同意,并签署知情同意书。讨论:试验旨在证实腰丛-坐骨神经阻滞复合七氟烷可改善老年髋关节置换患者置换后认知功能障碍,并观察血清碱性成纤维细胞生长因子的表达变化,进一步探讨其治疗机制。
[Abstract]:Background: senile patients with cognitive dysfunction after total hip replacement are often complicated with cognitive dysfunction. Studies have shown that sevoflurane can regulate the expression of basic fibroblast growth factor (bFGF) associated with cognitive impairment in the brain. However, whether it can reduce the incidence of cognitive impairment after hip replacement has not been reported. The experiment hypothesized the anesthetic regimen of lumbar plexus-sciatic nerve block combined with sevoflurane. To reduce the incidence of cognitive impairment after hip replacement in elderly patients. Objective: to observe the effect of lumbar plexus-sciatic nerve block combined with sevoflurane on cognitive dysfunction after hip replacement in elderly patients. Methods: the study was prospective. A single center, open, randomized controlled clinical trial was conducted in Qinghai University affiliated Hospital, Qinghai Province, China. Seventy elderly patients with unilateral total hip replacement were randomly divided into two groups. The observation group received tracheal intubation general anesthesia after lumbar plexus and sciatic nerve block and maintained by sevoflurane inhalation. The patients in the control group were treated with routine tracheal intubation general anesthesia combined with intravenous propofol anesthesia. The patients were followed up for 3 days after replacement. The cognitive function of the patients was evaluated with the mini-mental state scale on the 3rd day after replacement. The secondary indexes of the experiment were the score of the patients with Montreal Cognitive Assessment scale and the level of serum basic fibroblast growth factor (BFGF) before and 1 day after replacement. Intraoperative blood loss and operation time; The other indexes were intraoperative, 1 after replacement. 3. D incidence of adverse reactions. The trial was approved by the ethics committee of Qinghai university affiliated hospital in Qinghai province, china. The study met the requirements of the Helsinki declaration formulated by the world medical association. Cheng Chun informed consent. The purpose of the study was to prove that lumbar plexus-sciatic nerve block combined with sevoflurane could improve cognitive impairment after hip replacement in elderly patients. The expression of serum basic fibroblast growth factor (bFGF) was observed and its therapeutic mechanism was discussed.
【作者单位】：青海大学附属医院麻醉科;
【分类号】：R614
【正文快照】： 文章快速阅读:腰丛-坐骨神经阻滞复合七氟烷的麻醉方案对老年髋关节置换患者置换后认知功能障碍的影响观察组:结局:对象:术中以腰丛及坐骨神经阻滞后行气管插管随访的时间:采用腰丛-坐骨神经阻滞老年单侧全全身麻醉,配合采取吸入七氟烷麻醉维持置换后1,3 d复合七氟烷的麻醉方

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