【摘要】 目的:探讨超声引导下髂筋膜间隙阻滞(FICB)对老年全髋关节置换术(THA)患者术后神经认知功能及炎症因子的影响。方法:按照术后镇痛方式不同将90例择期行THA术的患者分为观察组(n=45)与对照组(n=45);术后观察组行超声引导下FICB,穿刺置管后予以负荷量0.3%罗哌卡因30 mL,然后连接镇痛泵持续输注0.2%罗哌卡因；对照组使用经静脉患者自控镇痛。记录两组术后VAS评分、补救镇痛情况及不良反应等；并于术前1 d及术后1 d检测血清白细胞介素-6(IL-6)、IL-1β、肿瘤坏死因子-α(TNF-α)的表达水平，于术前及术后1、3、7 d进行简易精神状态评价量表(MMSE)评分以评定神经认知功能。结果:术后4、12、24、48 h,观察组的VAS评分低于对照组(P<0.05),且补救镇痛率低于对照组(P<0.05)。术后1 d,观察组血清IL-6、IL-1β、TNF-α水平均低于对照组(P<0.05)。术后1、3 d,观察组MMSE评分高于对照组，且PND发生率低于对照组，差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组(P<0.05)。结论:FICB能够有效减少老年THA患者术后神经认知功能障碍发生，减轻炎症反应可能是其作用机制之一。更多还原

【Abstract】 Objective:To investigate the effect of ultrasound-guided fascia iliaca compartment block(FICB) on postperative neurocognitive function and inflammatory factors in elderly patients undergoing total hip arthroplasty(THA).Methods:90 patients with THA were divided into observation group(n=45) and control group(n=45) according to different postoperative analgesia methods.After operation, the observation group received FICB under the guidance of ultrasound, after puncture and catheterization, the loading dose of 0.3% ropivacaine 30 ml was given, and then 0.2% ropivacaine was continuously infused through the analgesia pump.The Patient-controlled intravenous analgesia after operation was used in the control group.The postoperative VAS score, rescue analgesia and adverse reactions were recorded.The levels of interleukin-6(IL-6),interleukin-1(IL-1),tumor necrosis factor-α(TNF-α) were measured 1 day before operation and 1 day after operation, and the mini mental state assessment(MMSE) was used to evaluate the neurocognitive function 1 day before operation and 1,3,7 day after operation.Results:Compared with the control group, the VAS scores of the observation group at 4 h, 12 h, 24 h and 48 h after operation were lower(P<0.05),and the rescue analgesia rate was significantly lower(P<0.05).1 day after operation, the levels of IL-6,IL-1 and TNF-α in the observation group were significantly lower than those in the control group(P<0.05).The MMSE score of the observation group was higher than that of the control group on 1 and 3 d after operation, and the incidence of PND was lower than that of the control group, the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion: FICB can effectively reduce the incidence of postoperative neurocognitive dysfunction in elderly patients undergoing THA,and reducing the inflammatory response may be one of the mechanisms.更多还原