摘要目的:评价髂筋膜间隙阻滞(FICB)对全髋关节置换术老年患者术后谵妄的影响。方法:择期脊椎-硬膜外麻醉下行单侧全髋关节置换术老年患者102例，性别不限，年龄≥65岁，ASA分级Ⅱ或Ⅲ级，体重指数≤35 kg/m 2。采用随机数字表法分成2组( n＝51)：FICB组和PCIA组。术后FICB组在超声引导下髂筋膜间隙穿刺，穿刺成功后注入0.5%罗哌卡因30 ml负荷剂量，然后接自控镇痛泵，药物配方：0.25%罗哌卡因用生理盐水稀释至275 ml，背景输注速率5 ml/h，PCA剂量0.5 ml，锁定时间15 min；PCIA组连接自控镇痛泵，药物配方：芬太尼10 μg/ml用生理盐水稀释至100 ml，背景输注速率2 ml/h，PCA剂量1 ml，锁定时间10 min。2组镇痛至术后48 h，维持VAS评分≤4分。VAS评分>4分时，先按压镇痛泵，观察10～20 min，若VAS评分仍>4分，则静脉注射氟比洛芬酯50 mg补救镇痛。采用混淆评估法评估术后48 h内谵妄的发生情况。记录术后48 h内补救镇痛情况以及恶心呕吐、尿潴留、便秘和皮肤瘙痒的发生情况。分别于术前24 h和术后24、48 h时，测定血清IL-6、IL-8、TNF-α和S100β蛋白的浓度。 结果:与PCIA组比较，FICB组术后谵妄发生率降低，术后24和48 h时血清S100β蛋白浓度降低( P<0.05)，术后补救镇痛率、恶心呕吐、尿潴留、便秘和皮肤瘙痒的发生率、各时点血清IL-6、IL-8和TNF-α的浓度差异无统计学意义( P>0.05)。 结论:FICB可减少全髋关节置换术老年患者术后谵妄的发生。

abstractsObjective:To evaluate the effect of fascia iliaca compartment block (FICB) on postoperative delirium in elderly patients undergoing total hip arthroplasty (THA).Methods:One hundred and two patients of both sexes, aged ≥ 65 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with body mass index ≤ 35 kg/m 2, undergoing elective THA under combined spinal-epidural anesthesia, were divided into 2 groups ( n=51 each) using a random number table method: FICB group and patient-controlled intravenous analgesia (PCIA) group.In group FICB, FICB was performed under ultrasound guidance after operation, 0.5% ropivacaine 30 ml (a loading dose) was given after successful insertion of the catheter, then the analgesic pump was connected, the analgesia solution contained 0.25% ropivacaine in 275 ml of normal saline, and the pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 5 ml/h.In group PCIA, the PCIA solution contained fentanyl 10 μg/ml in 100 ml of normal saline, and the pump was set up with a 1 ml bolus dose, a 10 min lockout interval and background infusion at a rate of 2 ml/h.Analgesia was maintained until 48 h after operation, and the visual analogue scale (VAS) score was maintained ≤4 in the two groups.When the VAS score was >4, the analgesic pump was pressed first followed by 10-20 min of observation.When the VAS score was still >4, flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.The Confusion Assessment Method was used to assess the development of delirium within 48 h after operation.The requirement for rescue analgesia and development of nausea and vomiting, urinary retention, constipation and pruritus were recorded within 48 h after operation.The serum concentrations of interleukin-6 (IL-6), IL-8, tumor necrosis factor-alpha and S100β protein were measured at 24 h before operation and 24 and 48 h after operation. Results:Compared with group PCIA, the incidence of postoperative delirium was significantly decreased after operation, the serum concentration of S100β protein was decreased at 24 and 48 h after operation ( P<0.05), and no significant change was found in the requirement for rescue analgesia, incidence of nausea and vomiting, urinary retention, constipation and pruritus after operation, and serum concentrations of IL-6, IL-8 and tumor necrosis factor-alpha at each time point in group FICB ( P>0.05). Conclusion:FICB can reduce the development of postoperative delirium in elderly patients undergoing THA.