全身麻醉联合髂筋膜间隙阻滞对老年全髋关节置换术患者炎症因子、肾灌注及预后的影响

Effects of general anesthesia combined with fascia iliaca compartment block on inflammatory factors, renal perfusion, and prognosis in elderly patients undergoing total hip arthroplasty

摘要:

目的 探讨全身麻醉联合髂筋膜间隙阻滞（FICB）对老年全髋关节置换术患者术后血清炎症因子、肾灌注相关指标及预后转归的影响。方法 采用前瞻性随机对照研究设计，选取2023年1月—2024年12月在成都市青白江区人民医院和四川大学附属成都市第二人民医院拟行单侧全髋关节置换术的240例老年患者为研究对象，采用随机数字表法将患者分为观察组与对照组，各120例。对照组采用单纯全身麻醉，观察组采用全身麻醉联合FICB。分别于术前1 d及术后6、24、48 h检测患者血清肌酐（Scr）、血尿素氮（BUN）、估算肾小球滤过率（eGFR）及血气指标，采用视觉模拟评分法（VAS）评估疼痛，记录镇痛药量、下床时间、住院时间及不良反应。采用Pearson相关分析法探讨血清炎症因子与VAS评分及肾灌注指标的相关性。结果 术前两组血清炎症因子及肾灌注相关指标比较，差异均无统计学意义（P >0.05）。术后6、24、48 h两组血清C反应蛋白（CRP）、降钙素原（PCT）水平及VAS评分均较术前升高，且于术后24 h达峰值后逐渐下降，但观察组各时点上述指标均低于对照组（P <0.05）。术后6、24 h，两组Scr、BUN、乳酸（Lac）水平均较术前升高（P <0.05），eGFR、动脉血氧分压（PaO₂）水平较术前降低，至术后48 h逐渐恢复，观察组上述指标的异常波动幅度均小于对照组（P <0.05），而两组pH值、碳酸氢根（HCO₃^-）水平无明显变化（P >0.05）。与对照组相比，观察组术后舒芬太尼总使用量显著减少（P <0.05），首次下床活动时间、住院时间均明显缩短（P <0.05），术后72 h内麻醉相关不良反应总发生率降低（P <0.05）。Pearson相关性分析结果显示，血清CRP、PCT与VAS评分、Scr、BUN、Lac均呈正相关（P <0.05），与估算eGFR、PaO₂均呈负相关（P <0.05）。结论 全身麻醉联合FICB应用于老年全髋关节置换术，可显著降低患者术后血清CRP、PCT等炎症因子水平，减轻术后疼痛，减少镇痛药物使用量，促进患者早期康复，降低不良反应发生率。

Abstract:

Objective To explore the effects of general anesthesia combined with fascia iliaca compartment block (FICB) on postoperative serum inflammatory factors, renal perfusion-related indicators, and prognosis in elderly patients undergoing total hip arthroplasty.Methods A prospective randomized controlled study design was adopted. From January 2023 to December 2024, 240 elderly patients scheduled for unilateral total hip arthroplasty in People's Hospital of Qingbaijiang District and The Second People's Hospital of Chengdu, Sichuan University were selected as study subjects. Using a random number table method, the patients were divided into an observation group (n = 120) and a control group (n = 120). The control group received general anesthesia alone, while the observation group received general anesthesia combined with FICB. Serum creatinine (Scr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), and blood gas indicators were detected on 1 day before surgery, and at 6, 24, and 48 hours after surgery. Pain was assessed using the Visual Analogue Scale (VAS), and analgesic consumption, time to ambulation, hospital stay, and adverse reactions were recorded. Pearson correlation analysis was used to explore the correlation between serum inflammatory factors and VAS scores, as well as renal perfusion indicators.Results Before surgery, there were no statistically significant differences in serum inflammatory factors and renal perfusion-related indicators between the two groups (P > 0.05). At 6, 24, and 48 hours after surgery, the levels of serum C-reactive protein (CRP), procalcitonin (PCT), and VAS scores in both groups were higher than those before surgery, peaking at 24 hours and then gradually decreasing. However, these indicators in the observation group were lower than those in the control group at each time point (P < 0.05). At 6 and 24 hours after surgery, the levels of Scr, BUN, and lactate (Lac) in both groups were higher than preoperative levels, while eGFR and arterial partial pressure of oxygen (PaO₂) were lower, gradually recovering by 48 hours. The abnormal fluctuations of the above indicators in the observation group were smaller than those in the control group (P < 0.05), while pH and bicarbonate (HCO₃^-) levels showed no significant change (P > 0.05). Compared with the control group, the observation group had significantly reduced total postoperative sufentanil consumption, shorter time to first ambulation and hospital stay, and a lower total incidence of anesthesia-related adverse reactions within 72 hours after surgery (P < 0.05). Pearson correlation analysis showed that serum CRP and PCT levels were positively correlated with VAS scores, Scr, BUN, and Lac (P < 0.05), and negatively correlated with eGFR and PaO₂^- (P < 0.05).Conclusion The application of general anesthesia combined with FICB in total hip arthroplasty for elderly patients can significantly reduce postoperative serum levels of inflammatory factors such as CRP and PCT, alleviate postoperative pain, reduce analgesic consumption, promote early recovery, and lower the incidence of adverse reactions.