不同麻醉方式对高龄患者髋关节术后重症监护室谵妄发生的影响  

The influence of general and spinal anesthesia on post-operative ICU delirium in very elderly patients with hip operation

作　　者：陈婉南[1] 宣丽真[1] 诸杜明[1] 郑毅隽[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,重症医学科,上海市200032

出　　处：《老年医学与保健》2015年第4期218-220,共3页Geriatrics & Health Care

摘　　要：目的探讨蛛网膜下腔麻醉和全身麻醉对高龄患者髋关节术后重症监护室（ICU）谵妄发生的影响。方法选择2013年1月至2014年12月期间，入住复旦大学附属中山医院外科ICU的择期髋关节手术术后，年龄80岁及以上且术前认知功能正常的患者；记录每日CAM-ICU评分评估谵妄发生情况，记录手术时间、麻醉方式、术后镇痛方式、疼痛评分、术后ICU入住时间、术后并发症发生情况、总住院时间以及麻醉费用。结果在高龄择期髋关节手术患者当中，全麻患者术后ICU谵妄的发生率高于蛛网膜下腔麻醉患者，且前者术后ICU入住时间、术后并发症发生情况、总住院时间以及麻醉费用均超过后者。结论对高龄择期髋关节手术患者采用蛛网膜下腔麻醉与全身麻醉相比，前者有利于减少术后ICU谵妄的发生。Objective To investigate the influence of subarachnoid anesthesia and general anesthesia on postoperative delirium in ICU in elderly patients with hip operation. Methods Very eldrly （≥ 80 years old） patients with normal preoperative cognitive and elective hip operation in SICU of Zhongshan hospital from 1st January 2013 to 31st December 2014 were studied,. Their daily CAM-ICU scores, operation time, anesthesia method, postoperative pain control, pain score, length of post-operative SICU stay, the incidence of postoperative delirium, postoperative complications, hospitalization time and cost of anesthesia were recorded. Results In very elderly patients after elective hip operation, patients with general anesthesia showed a higher incidence of postoperative delirium in ICU comparing with subarachnoid anesthesia, with longer post-operative SICU stay and hospitalization time, more post operative complications and higher anesthesia cost. Conclusion In very elderly patients with elective hip operation, subarachnoid anesthesia, rather than general anesthesia, may decrease postoperative delirium in ICU.

关 键 词：高龄 ICU 谵妄全麻 蛛网膜下腔麻醉 

分 类 号：R614[医药卫生—麻醉学]