| Objective :To explore the influence of Fascia Iliaca space Block(FICB)on inflammation and cognitive function in the elderly after hip replacement.Methods:A total of 80 elderly patients with hip replacement under elective general anesthesia in The Sixth Affiliated Hospital of Kunming Medical University from January 2022 to October 2022 were collected,including 38 males and 42 females.The age of the selected patients was 60-87 years old,ASAⅡ-Ⅲ.The selected cases were randomly divided into two groups,with 40 cases in each group,namely the simple general anesthesia group(group C,n=40)and the ultrasound-guided iliacfascia block combined general anesthesia group(group N,n=40).Group C underwent surgery under conventional general anesthesia intubation,group N underwent iliac fascia space block on the affected side under ultrasound guidance before general anesthesia induction,and was given 0.25% ropivacaine 30 ml,and then underwent general anesthesia intubation after the block was completed.Induction drugs in both groups were: etomidate 0.3mg/kg,Sufentanil 0.4ug/kg,vecuronium bromide0.1mg/kg intravenous injection,and intraoperative anesthesia was maintained by intravenous aspiration combined: Remifentanil(0.1-0.3ug/kg/min),propol(4-8mg/kg/h)and 1%-2% sevoflurane were pumped continuously,and vecuronium bromide was added as needed to maintain the BIS value of 40-60.The tidal volume and respiratory rate were adjusted to maintain end-respiratory carbon dioxide at 35-45 mm Hg.The mean arterial pressure(MAP)and heart rate(HR)changes were recorded in the two groups at different time points at home invasion(T0),immediately after intubation(T1),after lateral decubitus(T2),immediately after cuticle resection(T3),immediately after medullary cavity expansion(T4),and immediately after extubation(T5).Operation duration,intraoperative narcotic and analgesic drug dosage,blood loss,infusion volume and urine volume were recorded.Peripheral venous blood 2-4ml was extracted from the two groups before surgery(T0),24h(T6),48h(T7)and 72h(T8),respectively,and routine blood routine(white blood cell count WBC,platelet count PLT)and infectious markers were performed:Calcitonin(PCT),interleukin-6(IL-6)and C-reactive protein(CRP)were examined and the relevant data were recorded.Visual Analogue Scale(VAS)scores were performed before surgery(T0),immediately after extubation(T5),24 hours after surgery(T6)and 48 hours after surgery(T7).The Simple Mental State Scale(MMSE)scoring system was used to score cognitive function before surgery(T0),1 day(T6),3day(T8),5 day(T9)and 7 day(T10).Results:Compared with group C,HR in group N at T1,T2,T3,T4 and T5 were decreased,and the difference was statistically significant(P<0.05).Serum CRP level at T6 and T7 was lower than that in C group,and the difference was statistically significant(P<0.05),but no significant change was found at T8(P>0.05).The serum IL-6 level in T6,T7 and T8 was lower than that in C group,and the difference was statistically significant(P<0.05).Serum WBC and PLT levels in T6,T7 and T8 were lower than those in C group,and the difference was statistically significant(P<0.05).VAS scores in T5,T6 and T7 were lower than those in C group,and the difference was statistically significant(P<0.05).MMSE scores in T6 were hiaher than those in C group,and the difference was statistically significant(P<0.05).The doses of sufentanil and remifentanil during the operationwere significantly reduced and statistically significant(P <0.05).Conclusion(s): Iliofascial space block can reduce the release of inflammatory factors after hip replacement in elderly patients,reduce inflammatory response,and facilitate early rehabilitation of patients;Iliac fascia space block can reduce the incidence of early POCD after hip replacement in elderly patients,which is more beneficial for postoperative cognitive function rehabilitation in elderly patients;Iliac fascia space block has a good effect on intraoperative and postoperative analgesia in elderly patients with hip replacement. |
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