全身麻醉和股神经阻滞复合喉罩全麻对老年骨科患者POCD影响的比较  

Comparison of the influence of POCD of general anesthesia and femoral nerve block combined with laryngeal mask airway general anesthesia on elderly patients in the department of orthopedics

作　　者：莫力[1] 何庆标[1] 何运平[1] 张绍杰[1] 

机构地区：[1]武警广东省总队医院麻醉科,广东广州510000

出　　处：《中国医学工程》2015年第7期22-23,共2页China Medical Engineering

摘　　要：目的对比分析全身麻醉和股神经阻滞复合喉罩对老年骨科患者术后认知功能的影响。方法将60例择期行骨科手术的老年患者（≥60岁,ASA分级Ⅰ∽Ⅱ级）按照抽签随机取样法均分为2组。A组给予全身麻醉,B组给予股神经阻滞复合喉罩全麻。比较两组患者麻醉前、术后6 h、24 h、72 h、5 d简易智能精神状态评分（MMSE）及血清S-100β蛋白水平。比较两组患者术后苏醒时间、拔管时间、恶心呕吐发生率及认知功能障碍（POCD）发生率。结果麻醉前,两组MMSE评分、血清S-100β蛋白水平比较差异均无统计学意义（P〉0.05）。术后6 h,两组MMSE评分均明显下降（P〈0.05）,S-100β蛋白水平均开始呈现上升趋势;术后第5天,B组患者基本恢复正常,而A组患者未恢复至麻醉前水平。两组术后不同时间点MMSE评分、血清S-100β蛋白水平比较差异有统计学意义（P〈0.05）。两组患者苏醒时间、拔管时间比较差异无统计学意义（P〉0.05）,B组患者恶心呕吐及POCD发生率显著低于A组（P〈0.05）。结论相对于全身麻醉醉,股神经阻滞复合全麻应用于老年骨科手术患者对其术后认知功能影响小,POCD的发生率较低,是老年患者适宜的麻醉方式。【Objective】To compare and analyze the General anesthesia and femoral nerve block combined with laryngeal mask airway on cognitive function in elderly patients in the department of orthopedics after operation. 【Methods】60 elderly patients undergoing operation in the department of orthopedics（over 60 years old, ASA grade I ∽ II） were selected were divided into 2 groups according to the draw random sampling. The patients in Group A were givengeneral anesthesia while the patients in Group B were given femoral nerve block combined with laryngeal mask airway anesthesia. Comparison of two groups of patients before anesthesia, postoperative 6 h, 24 h, 72 h, 5D, mini mental status score（MMSE） score and serum levels of S-100 beta protein.. The postoperative recovery time, tube drawing time, the incidence of nausea and vomiting and the incidence of cognitive dysfunction（POCD） in the patients in two groups were compared. 【Results】Before anesthesia, MMSE score and serum S-100β protein level of the patients in two groups were not significant（P〈0.05）. After operation, MMSE score of the two groups of was significantly decreased（P〈0.05） while S-100β protein levels were beginning to show an upward trend. 5 days after operation, the patients group B returned to normal, but the patients in group A did not recover to the level before anesthesia. The MMSE score and serum S-100β protein level in two groups had statistical significance at different time points after operation（P〈0.05）. The comparison of differences of the recovery time and tube drawing time of the patients in two groups was not significant（P〈0.05）. The incidence of nausea and vomiting and the incidence of cognitive dysfunction（POCD） in the patients in group B were lower than those in group A（P〈0.05）. 【Conclusion】Compared General anesthesia, femoral nerve block combined with general anesthesia has little postoperative cognitive function influence on elderly patients in the department of orthopedics and the

关 键 词：骨科手术 麻醉 术后认知功能 

分 类 号：R816.8[医药卫生—放射医学]