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目的 超声引导下髋关节囊周围神经(PENG)阻滞联合硬膜外麻醉对股骨头置换术老年患者麻醉效果、术后认知功能及免疫功能的影响。方法 选取2021年6月至2024年7月成都市中西医结合医院收治的120例行股骨头置换术的老年患者，采用随机数字表法将患者分为对照组(n=60)和研究组(n=60)，年龄> 60岁，美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级，研究组接受超声引导下PENG阻滞联合硬膜外麻醉，对照组仅行硬膜外麻醉。比较两组患者的血流动力学指标(心率、平均动脉压)、免疫功能[CD4+、CD4+/CD8+、调节性T细胞(CD4~+CD25+)]、简易智力状态检查评分(MMSE)、术后认知功能障碍(POCD)发生率、视觉模拟评分法(VAS)。结果 研究组麻醉后心率、平均动脉压波动低于对照组(P<0.05)；研究组术后6、24、72 h的CD4+、CD4+/CD8+高于对照组，CD4~+CD25+低于对照组(P<0.05)；研究组术后6 h、术后24 h、术后48 h MMSE评分明显高于对照组(P<0.05)；与对照组比较，研究组术后6、24 h POCD发生率明显降低(P<0.05)；研究组术后30 min、2 h VAS评分低于对照组(P<0.05)；术后24 h两组VAS评分差异无统计学意义(P > 0.05)。结论 超声引导下PENG阻滞联合硬膜外麻醉效果更佳，镇痛效果好，有利于降低对血流动力学和免疫功能的影响，更快恢复认知，降低POCD发生率。
Abstract：Objective To explore the effects of ultrasound-guided pericapsular nerve group(PENG) block of the hip joint combined with epidural anesthesia on the anesthetic effect, postoperative cognitive function and immune function in elderly patients undergoing femoral head replacement surgery. Methods A total of 120 elderly patients, aged > 60 years, of American Society of Anesthesiologists(ASA) physical status classification Ⅰ or Ⅱ, who underwent femoral head replacement surgery at Chengdu Hospital of Integrated Traditional Chinese and Western Medicine from June 2021 to July 2024 were selected. The patients were randomly divided into the control group(n=60) and the study group(n=60) using a random number table method. The study group received ultrasound-guided PENG block combined with epidural anesthesia, while the control group only received epidural anesthesia. The hemodynamic indicators(heart rate, mean arterial pressure), immune function [CD4+, CD4+/CD8+, regulatory T cells(CD4~+CD25+)], mini mental state examination score(MMSE), incidence of postoperative cognitive dysfunction(POCD), visual analogue scale(VAS) were compared between the two groups. Results The fluctuation of heart rate and mean arterial pressure in the study group was lower than that in the control group after anesthesia(P < 0.05). The research group exhibited elevated CD4+ and CD4+/CD8+ ratios but reduced CD4~+CD25+ levels at 6, 24, 72 h postoperatively versus the control group(P < 0.05). Compared with the control group, the research group demonstrated higher MMSE scores at 6, 24, 48 h post-operatively and lower POCD incidence at 6, 24 h after the operation(P < 0.05). Compared with the control group, the research group showed reduced VAS scores at 30 min and 2 h after the operation,(P < 0.05); there was no statistically significant difference in VAS scores between the two groups at 24 h after the operation(P > 0.05). Conclusion Ultrasound guided PENG block combined with epidural anesthesia is more effective, with good analgesic effects, which is conducive to reducing the impacts on hemodynamics and immune function, enhancing faster cognitive recovery, and reducing the incidence of postoperative cognitive dysfunction.
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基本信息:
中图分类号:R614
引用信息:
[1]赖广益,邹妲婧,陆燕萍,等.超声引导下PENG阻滞联合硬膜外麻醉对老年股骨头置换术的影响[J].麻醉安全与质控,2025,7(06):483-488.
基金信息:
四川省卫生健康科研课题（20SYJS26）
2025-12-15
2025-12-15
2025-12-15