不同麻醉及术后镇痛方式对老年股骨骨折患者术后早期认知功能的影响

发布时间：2018-02-27 00:00

本文关键词： 麻醉全身麻醉和镇痛股骨骨折外科手术认知障碍老年人　出处：《临床误诊误治》2016年10期 　论文类型：期刊论文

【摘要】：目的比较不同麻醉及术后镇痛方式对于老年股骨骨折患者术后早期认知功能的影响。方法选取择期行手术治疗的老年股骨颈或股骨粗隆骨折患者75例,根据麻醉及术后镇痛方式的不同均分为静脉全身麻醉组(GA组)、腰硬联合麻醉组(CSEA组)和神经阻滞组(NB组)。GA组给予静脉全身麻醉及术后静脉镇痛泵镇痛,CSEA组给予腰硬联合麻醉及术后硬膜外自控镇痛,NB组给予腰丛神经、坐骨神经阻滞及术后腰丛神经自控镇痛。观察并记录各组术后6、12、24、48 h疼痛视觉模拟评分(visual analogue scale,VAS),术前和术后1、3、7 d简易智力状态检查量表(MMSE)评分,以及术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生情况。结果 CSEA组、NB组术后6、12、24、48 h VAS评分均低于GA组(P0.05或P0.01);术后1 d MMSE评分NB组CSEA组GA组,差异均有统计学意义(P0.05);术后3 d MMSE评分,NB组CSEA组和GA组,差异有统计学意义(P0.05);3组术后1 d MMSE评分与麻醉前比较明显降低(P0.05)。术后1、3 d NB组POCD发生率均低于其他两组,差异均有统计学意义(P0.05或P0.01);且术后1 d GA组POCD发生率高于CSEA组(P0.05);术后7 d 3组均无POCD发生。结论老年股骨手术患者全身麻醉较其他麻醉方式有更高的早期POCD发生率,神经阻滞可能是老年股骨手术更为安全、有效的麻醉和术后镇痛方式。
[Abstract]:Objective to compare the effect of different anaesthesia and postoperative analgesia on the early postoperative cognitive function in elderly patients with femoral fracture. Methods 75 elderly patients with femoral neck or femoral trochanteric fractures were selected for elective surgical treatment. According to the different anaesthesia and postoperative analgesia methods, they were divided into intravenous general anesthesia group (GA group), spinal epidural anesthesia group (CSEA group) and nerve block group (NB group). GA group was given intravenous general anesthesia and postoperative intravenous analgesia pump analgesia (CSEA group). Combined epidural anesthesia and postoperative patient-controlled epidural analgesia were given to lumbar plexus nerve in NB group. Sciatic nerve block and postoperative lumbar plexus analgesia were observed and recorded. Visual analogue scale scale and MMSE score were observed and recorded in each group after operation for 48 h, 1 day before and 3 days after operation, 3 days after operation, and 7 days after operation, the scores of visual analogue of pain and visual analogue scale were recorded. Results the VAS scores in CSEA group were significantly lower than those in GA group (P 0.05 or P 0.01), and MMSE scores in NB group were significantly lower than those in CSEA group at 1 day after operation. There were significant differences in the MMSE scores between NB group and CSEA group and GA group on the 3rd day after operation. The MMSE score on the 1st day after operation in the NB group and the GA group was significantly lower than that before anesthesia. The incidence of POCD in NB group was lower than that in the other two groups on the 1st day after operation, and the incidence rate of POCD in the NB group was lower than that in the other two groups on the 1st day after operation. The incidence of POCD in GA group was higher than that in CSEA group on the 1st day after operation, and no POCD occurred in 3 groups on the 7th day after operation. Conclusion the incidence of early POCD in elderly patients undergoing general anesthesia is higher than that in other anesthesia methods. Nerve block may be a more safe and effective anaesthesia and postoperative analgesia for senile femur surgery.
【作者单位】：珠海市人民医院麻醉科;
【分类号】：R614

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