不同麻醉方式对老年骨科患者血流动力学及认知功能的影响  

Effects of Different Anesthesia Methods on Hemodynamics and Cognitive Function of Elderly Patients in Orthopedics Department

作　　者：李鹤[1] 李传翔[1] 宋冬梅[1] 王国栋[1] 

机构地区：[1]南方医科大学第三附属医院麻醉科,广州510630

出　　处：《解放军医药杂志》2015年第5期86-89,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的探讨不同麻醉方式对老年骨科手术患者血流动力学及认知功能的影响。方法选择2011年7月—2013年11月在南方医科大学第三附属医院骨科进行手术的老年患者180例为研究对象,随机分为静吸复合麻醉组(A组)、全凭静脉麻醉组(B组)和硬膜外麻醉组(C组),每组60例。观察3组血流动力学变化、麻醉恢复情况,比较镇静评分,采用简易精神状况检查量表(MMSE)评价认知功能。结果手术开始后30 min、手术结束时,B组DBP低于A、C组(P<0.05);手术开始后10、30 min,C组镇静评分均低于A、B组(P<0.05)。C组苏醒与意识恢复时间均短于A、B组,A、C组呼吸满意时间均短于B组(P<0.05)。C组手术开始后12、24 h认知功能评分均高于A、B组(P<0.05)。结论硬膜外麻醉可减轻老年骨科手术患者血流动力学影响及术后认知功能障碍,镇静效果好,苏醒及意识恢复时间更短。Objective To analyze the effects of different anesthesia methods on hemodynamics and cognitive function of elderly patients in orthopedics department. Methods A total of 180 elderly patients undergoing operations during July 2011 and November 2013 in orthopedics department were randomly divided into group A（ intravenous inhalation anesthesia,n = 60）,group B（ total intravenous anesthesia,n = 60） and group C（ epidural anesthesia,n = 60）.The hemodynamic changes and recovery conditions of anesthesia in all patients were observed,and the sedation scores were compared,and then the mini-mental state examination（ MMSE） scale was used to evaluate the cognitive function in the three groups. Results Diastolic blood pressure（ DBP） values at 30 thmin after the surgery and at the end of surgery in group B were lower compared with those in group A and C（ P〈0. 05）. The sedation scores in group C at 10 thand 30th min after the surgery were lower compared with those in group A and B（ P〈0. 05）. The palinesthesia time and consciousness recovery time in group C were shorter compared with those in group A and B（ P〈0. 05）,and respiratory satisfaction time in group A and C were significantly shorter compared with that in group B（ P〈0. 05）. Cognitive function scores at 12^th and 24^th h after the surgery in group C were significantly higher than those in group A and B（ P〈0. 05）.Conclusion Epidural anesthesia for elderly patients in orthopedics department can effectively decrease the effects of hemodynamics and postoperative cognitive dysfunction with good intraoperative sedation and speed up palinesthesia time and consciousness recovery time.

关 键 词：麻醉 吸入 麻醉 静脉 麻醉 硬膜外 认知障碍 骨折 老年人 

分 类 号：R614[医药卫生—麻醉学]