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  • 陈 强,张瓅韫,黄 亮,等.神经阻滞麻醉降低近端髓内钉治疗高龄股骨粗隆间骨折术后谵妄的随机对照研究[J].同济大学学报(医学版),2019,40(4):460-468.    [点击复制]
  • CHEN Qiang,ZHANG Li-yun,HUANG Liang,et al.Nerve block anesthesia reduces postoperative delirium in patients undergoing internal fixation with PFNA: a randomized controlled trial study[J].同济大学学报(医学版),2019,40(4):460-468.   [点击复制]
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神经阻滞麻醉降低近端髓内钉治疗高龄股骨粗隆间骨折术后谵妄的随机对照研究
陈强,张瓅韫,黄亮,郑龙坡,陶坤,丛锐军
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(上海市虹口区江湾医院骨科,上海 200434;海军军医大学附属上海长征医院影像科,上海 200003;同济大学附属第十人民医院医学装备处,上海 200072;同济大学附属第十人民医院骨科,上海 200072)
摘要:
目的 探讨神经阻滞麻醉能否有效降低防旋型股骨近端髓内钉(proximal femoral nail antirotation, PFNA)内固定术后谵妄发生率。方法 采用临床随机对照试验方法,3个中心共100例股骨粗隆间骨折,计算机随机数法随机分为实验组和对照组,各50例。比较分析两组术前及术后3、7、14d的SF-36评分、Harris评分、CAM-ICU评价(confusion assessment method for the intensive careuint, CAM-ICU)和MMSE评分(mini mental state exam, MMSE)。结果 术前各组基线齐,各组无脱漏。术后组间并发症差异无统计学意义(P>0.05)。术后3d,谵妄发生率组间差异有统计学意义(P<0.05),其余时间点无统计学意义(P>0.05)。术后3d,试验组Harris评分、SF-36评分、MMSE评分(38.1±6.2、55.6±8.9、26.7±2.4)均高于对照组(34.4±7.2、50.6±9.0、25.3±2.7,P<0.05);术后7d,试验组的Harris评分、MMSE评分(40.9±6.3、29.1±1.6)高于对照组(37.0±7.4、28.3±1.9,P<0.05);术后14d,试验组的Harris评分、SF-36评分(51.5±9.3、73.5±11.1)高于对照组(47.78±9.1、68.0±11.1,P<0.05),而MMSE评分组间差异没有统计学意义(P>0.05)。CAM-ICU评价谵妄发生率和MMSE评分、SF-36评分相关性强(r分别为-0.814和-0.887,P<0.01),术后3d谵妄发生率和术后3次随访Harris评分之间相关性弱(r分别为-0.152、-0.171和-0.040,P分别为0.130、0.089和0.692)。结论 神经阻滞麻醉能满足PFNA内固定手术要求,能有效降低术后谵妄的发生率,提高患者精神评分,加快患者术后康复,是PFNA内固定手术值得选择的麻醉方式。
关键词:  谵妄  髋部骨折  局部麻醉; 骨钉; 老年人
DOI:10.16118/j.1008-0392.2019.04.012
投稿时间:2018-10-18
基金项目:上海市虹口区科学技术委员会2015—2017年医疗卫生重点专科科研课题(KA53000002014074)
Nerve block anesthesia reduces postoperative delirium in patients undergoing internal fixation with PFNA: a randomized controlled trial study
CHEN Qiang,ZHANG Li-yun,HUANG Liang,ZHENG Long-po,TAO Kun,CONG Rui-jun
(Dept. of Orthopedics, Shanghai Hongkou District Jiangwan Hospital, Shanghai 200434, China;Dept. of Radiology, Changzheng Hospital of Naval Medical University, Shanghai 200003, China;Dept. of Medical Equipment, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China;Dept. of Orthopedics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China)
Abstract:
Objective To investigate the effect of local nerve block anesthesia on postoperative delirium in patients undergoing internal fixation with proximal femoral nail antirotation (PFNA). Methods In this random controlled trial 100 patients with femoral intertrochanteric fracture from 3 center undergoing internal fixation with PFNA were randomly assigned in two groups: 50 cased in the trial group received local nerve block anesthesia and 50 cases in the control group received general anesthesia. The SF-36 score, the Harris score, the confusion assessment method for the intensive care unit (CAM-ICU) and the mini mental state exam (MMSE) score before operation and 3, 7 and 14d after the operation were assessed and compared between two groups. Results All the patients were followed up. There was no significant difference in postoperative complications between two groups(P>0.05). The delirium rate at d3 after operation in trial group was significantly lower than that in control group (P<0.05). The SF-36 score, the Harris score and the MMSE score at d3 after the operation in trial group were higher than those in control group (38.1±6.2 vs 34.4±7.2,55.6±8.9 vs 50.6±9.0, 26.7±2.4 vs 25.3±2. 7; all P<0.05). The Harris score and the MMSE score at d7 after the operation, the SF-36 score and the Harris at d7 after the operation in trial group were significantly higher than those in control group (all P<0.05). The CAM-ICU was strongly correlated with the Harris score and MMSE score(r=-0.814 and -0.887, respectively, P<0.01). Conclusion The local nerve block anesthesia can alleviate delirium and accelerate postoperative recovery in patients underwent PFNA operation.
Key words:  delirium  hip fractures  local anesthesiaq  bone nails  the elderly

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