老年患者髋关节置换术后早期认知功能障碍的因素分析
Risk factors for early postoperative cognitive dysfunction in elderly patients undergoing hip joint replacement
黄志莲 1李军 1连庆泉 1李兴旺 1朱丽丹2
作者信息
- 1. 325027,温州医学院附属第二医院麻醉科
- 2. 325027,温州医学院附属第二医院检验科
- 折叠
摘要
目的 分析影响老年患者髋关节置换术后早期认知功能障碍(POCD)的因素.方法 择期髋关节置换术老年患者33例,随机分为2组:静吸复合全麻组(G组,n=15)和脊椎.硬膜外麻醉组(E组,n=18).术中收缩压波动幅度不超过基础值的25%,SpO2≥95%.术后48 h静脉输注0.001%芬太尼2 ml/h镇痛.于麻醉诱导前、术后3 h、6 h、1 d、3 d时记录MMSE评分;采集颈内静脉血样,测定血清S-100β蛋白及神经元特异性烯醇化酶(NSE)浓度.计算麻醉诱导前MMSE评分的标准差,每例患者以麻醉诱导前评分为对照,术后评分与麻醉诱导前比较≥1个标准差时即判断发生POCD.根据术后3 h有无POCD分为POCD组(A组)和无POCD组(B组).结果 E组术后3 h时POCD发生率(22%)低于G组(67%)(P＜0.05).与麻醉诱导前比较,G组和A组术后3、6 h、1 d时、E组和B组术后3、6 h时S-100β蛋白和NSE浓度均升高(P＜0.05或0.01);与术后3 h比较.4组术后其余时点S-100β蛋白浓度均降低,G组和B组术后3 d时NSE浓度降低(P＜0.01);与G组比较,E组术后3 h时NSE浓度降低(P＜0.05);与A组比较,B组术后3 h时S-100β蛋白浓度降低,术后6 h时NSE浓度降低(P＜0.05或0.01).结论 髋关节置换术老年患者行全身麻醉较行脊椎.硬膜外麻醉术后早期POCD发生率高,且与S-100β蛋白和NSE浓度的升高有关.
Abstract
Objective To investigate the risk factors for early postoperative cognitive dysfunction(POCD)in elderly patients undergoing hip joint replacement.Methods Thirty-three ASA Ⅱ patients aged 65-92 yr undergoing hip joint replacement were randomly divided into 2 groups:group Ⅰ general anesthesia(G,n=15)and group Ⅱ spinal-epidural anesthesia(S-E,n=18).In group G anesthesia was induced with fentanyl,propofol and vecuronium and maintained with sevoflurane inhalation and intermittent iv boluses of vecuronium.The patients were mechanically ventilated after tracheal intubation.PET CO2 was maintained at 30-40 mm Hg.In group S-E combined spinal-epidural anesthesia was performed at L2,3 interspace.Hyperbaric 0.5% bupivacaine 7 mg was injected into subarachnoid space and epidural 0.25% bupivacaine 3-5 ml was given when needed.SP was maintained at baseline value ±25% and SpO2 was kept≥95% during operation.Postoperative analgesia was provided by iv infusion of 0.001%fentanyl at 2 ml/h for 48 h.The mean MMSE scores were calculated and recorded and venous blood samples were obtained for determination of serum concentrations of S-100 protein and neurone specific enolase(NSE)before anesthesia(baseline)and at 3 h,6 h,1 d and 3 d after operation.POCD was defined as the difference between pre-and postoperative mean MMSE score≥1 standard deviation(SD).The patients were also divided into POCD and non-POCD groups.Results Ten patients developed POCD in group G and 4 in group S-E.Serum concentrations of S-100 protein and NSE were significantly increased after operation as compared with the baseline values before anesthesia in both groups,and were significantly higher in POCD patients than in non-POCD patients.Conclusion In elderly patients the incidence of POCD is higher after general anesthesia than combined spinal-epidural anesthesia.The high POCD incidence is associated with increased serum concentrations of S-100 protein and NSE.
关键词
认知障碍/危险因素/老年人/关节成形术,置换,髋Key words
Cognition disorders/Risk factors/Aged/Arthroplasty,replacement,hip引用本文复制引用
出版年
2008
NETL
NSTL
维普
万方数据