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
Effect of Different Methods of Anesthesia and Postoperative Analgesia on Postoperative Early Cognitive Function in Elderly Patients with Femoral Fractures
张玫 1马中原 1周愚 1梁根强 1乔瑞冬1
作者信息
- 1. 519000广东珠海,珠海市人民医院麻醉科
- 折叠
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、7d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(P＜0.05或P＜0.01);术后1 d MMSE评分NB组＞CSEA组＞GA组,差异均有统计学意义(P＜0.05);术后3 d MMSE评分,NB组＞CSEA组和GA组,差异有统计学意义(P＜0.05);3组术后1 d MMSE评分与麻醉前比较明显降低(P＜0.05).术后1、3dNB组POCD发生率均低于其他两组,差异均有统计学意义(P ＜0.05或P＜0.01);且术后1dGA组POCD发生率高于CSEA组(P＜0.05);术后7d3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 effects of different methods of anesthesia and postoperative analgesia on postoperative early cognitive function in elderly patients with femoral fractures.Methods A total of 75 elderly patients with femoral neck or femoral trochanter fractures undergoing surgical treatment were divided into intravenous general anesthesia (GA) group combined spinal epidural anesthesia (CSEA) group and nerve block (NB) group according to anesthesia and postoperative analgesia methods.GA group was given intravenous general anesthesia and postoperative analgesia of intravenous analgesia pump;CSEA group was given CSEA and postoperative epidural self-controlled analgesia;NB group was given block of lumbar plexus and sciatic nerve and postoperative lumbar plexus nerve self-controlled analgesia.Among three groups,visual analogue scale (VAS) scores on postoperative 6th,12th,24th and 48th h,mini-mental state examination (MMSE) scores before surgery and at postoperative 1st,3rd 7th d and incidence rates of postoperative cognitive dysfunction (POCD) were also recorded.Results VAS scores on postoperative 6th,12th,24th and 48t h in CSEA and NB groups were lower than that in GA group (P ＜ 0.05 or P ＜0.01).MMSE scores at postoperative 1st d from high to low were NB group,CSEA group and GA group,and the differences were statistically significant (P ＜ 0.05);MMSE scores at postoperative 3rd d in NB group was higher than those in CSEA and GA groups,and the differences were statistically significant (P ＜ 0.05).Among three groups,MMSE scores at postoperative 1 sh d were significantly decreased compared with those before anesthesia (P ＜ 0.05);incidence rates of POCD at postoperative 1 st and 3rd d in NB group were lower than other two groups,and the differences were statistically significant (P ＜ 0.05 or P ＜ 0.01);the rate at postoperative 1 st d in GA group was higher than that in CSEA group (P ＜ 0.05);no POCD patient was found at postoperative 7th d in three groups.Conclusion General anesthesia for elderly patients with femoral surgery has higher incidence rate of early POCD compared with those by other anesthetic methods,so nerve block may be a safer and more effective method of anesthesia and postoperative analgesia for elderly patients with femoral surgery.
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Key words
Anesthesia, general/Anesthesia and analgesia/Femoral fractures/Surgery/Cognition disorders/Aged引用本文复制引用
出版年
2016
国家科技期刊平台
NSTL
万方数据