依托咪酯静脉全麻联合ficb对老年全髋关节置换术pocd的影响

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1、有统计学意义(P(0．05)；术后3d共有15例发生POCD，其中NE组(1例3．4％)较NS组(6例22．2％)和E组(8例25．O％)发生率降低，有统计学意义(尺0．05)；NS组和E组术后1d和术后3dPOCD发生率组间比较无明显差异(乃O．05)。7．三组患者术后均无术中知晓、穿刺部位感染及穿刺部位神经损伤的发生，NE组、NS组、E组术后恶心呕吐发生率分别为20．7％(6例)、14．896(4例)、28．1％(9例)，比较没有统计学意义(P)0．05)。8．三组患者术中瑞芬太尼用量(E组>NE组>NS组)比较具有显著差异(P(0．05)；术后镇痛药追加次数E组较NE组

2、和NS组明显增多(PC0．05)，NE组和NS组比较没有差异(fP0．05)。结论：依托咪酯静脉全麻联合FICB用于老年全髋关节置换可以减少术后早期POCD的发生率，并降低术后1d、术后3d的血清S100B蛋白、NSE浓度的升高程度，有一定的中枢保护作用。关键词：依托咪酯；七氟醚；血清S100B蛋白；术后认知功能障碍；髂筋膜腔隙阻滞；万方数据EffectofetomidateintravenousanesthesiacombinedFICBonPOCDinelderlypatientsundergoingtotalhipreplacementAbstractObjective

3、：Todiscusstheeffectofetomidateintravenousanesthesiacombinedfasciailiacacompartmentblockonpostoperativecognitivedysfunctioninelde．-rlypatientsundergoingtotalhipreplacement．Methods：Ninety．sixelderlypatientswhoarescheduledforunilateraltotalhipreplacementwereenrolledandrandomlydividedintothreeg

4、roups：etomidateintravenousanesthesiacombinedFICBgroup(groupNE，n=32)，sevofluraneanesthesiacombinedFICBgroup(groupNS，n=32)，etomidateintravenousanesthesiagroup(groupE，n232)．Thevitalsignsweremonitoredafterpatientsintotheoperatingroom，andinspiringoxygenwithmaskafterpremedicatedwithmidazolam0．03m

5、g／kg．Lineontheleftsideoftheradialarterypuncturecatheterunderlocalanesthesiatomonitorbloodpressure，andNEgroupandNSgroupneedtoapplyFICB．PatientswithnerveblookofsuccessandEgroupwereinducedwithintravenoussufentanil0．3ug／kg，etomidate0．2-0．3mg／kg，cisatracuriumO．15mg／kgfollowedbymaskinsertionandve

6、ntilation．Allthepatientsweregivenain．一fusionofremifentanilat0．08—0．3ug／kg／min．ThepatientsingroupNEandgroupEweregivenacontinuousintravenousinfusionofetomidateat7-14ug／-kg／min，whilethepatientsingroupNSweregivenasevofluraneanesthesiaat2-4％，andregulatedthedoseofetomidateorsevofluraneaccordingto

7、theBIStomaintaintheBISvaluebetween40to60．ThepatientsinthreegroupsweregiveaPCIA，andmaintainedtheVASscorelessthanorequalto3．MAP，FIR．4．．万方数据wererecordatpreoperative(TO)，beforecuttingleather(T1)，whenplacingprosthesis(T2)，aftertheoperation(T3)．Infusionvolumeo