不同麻醉方式对老年全髋关节置换术患者术后短期认知功能的影响  

Effects of different anesthesia methods on postoperative cognitive dysfunction in elderly patients undergoing total hip arthroplasty

作　　者：利鸿胜[1] 银含素 莫朴[1] 

机构地区：[1]茂名市人民医院麻醉手术科,广东茂名525000

出　　处：《中国当代医药》2016年第11期113-115,共3页China Modern Medicine

摘　　要：目的探讨对老年全髋关节置换术患者在术中采用不同麻醉方式,对其术后短期认知功能障碍(POCD)的影响。方法择期拟行全髋关节置换术的老年患者80例,按照数字表法随机分为腰硬联合麻醉组(E组)和全身麻醉组(G组),每组40例。记录并分析两组患者入室时(T_0)、麻醉开始时(T_1)、手术开始时(T_2)、手术开始30 min后(T_3)、手术结束时(T_4)的MAP与HR值,采用简易智力状态检查量表(MMSE)于术前1 d及术后3 d对患者进行神经心理评估,比较两组患者POCD及不良反应的发生情况。结果两组患者血压、心率组间相比,差异无统计学意义(P>0.05);两组患者术前1 d MMSE评分无明显差异(P>0.05),且术后3 d的MMSE评分(24.7±0.5),(20.6±0.6)分,均明显低于术前1 d的(28.3±0.4),(28.2±0.5)分,统计学上有意义(P<0.05);E组患者术后3 d的MMSE评分(24.7±0.5)分均明显高于G组(20.6±0.6)分,统计学上有意义(P<0.05)。E组患者的POCD发生率(10.0%)明显低于G组(27.3%)(P<0.05)。E组患者的不良反应发生率(17.5%)明显低于G组(37.5%)(P<0.05)。结论 POCD的发生机制较为复杂,对老年全髋关节置换术患者采用腰硬联合麻醉方式后,有效降低了不良反应发生率,应用效果较优。Objective To investigate effects of different anesthesia methods on postoperative cognitive dysfunction（POCD） in elderly patients undergoing total hip arthroplasty. Methods Eighty elderly patients undergoing total hip arthroplasty were randomly divided into combined spinal-epidural anesthesia group（group E） and General anesthesia group（group G）.MAP and HR were observed at the time of entering the OR（T_0）,anesthesia beginning（T_1）,surgery beginning（T_2）,30 min after the surgery beginning（T_3） and surgery ending（T_4）.Cognitive function was assessed on 1 day before operation and on 3 days after operation using mini mental state examination（MMSE）.The incidence of POCD and adverse reaction in two groups were compared. Results There were no significant difference in blood pressure and heart rate between two groups（P〉0.05）.MMSE scores showed no difference on 1 day before operation（P〉0.05）.MMSE scores on 3 days after operation（24.7±0.5）,（20.6±0.6） scores points were obviously lower than that on 1 day before operation（28.3±0.4）,（28.2±0.5） scores points in both group E and group G,the difference was significant（P〈0.05）.Group E on3 days after operation had a higher scores than group G [（24.4±0.5）scores vs（20.6±0.6）scores],the difference was significant（P〈0.05）.The incidence of POCD（10.0%） in group E was obviously lower than that of in group G（27.3%）（P〈0.05）. The incidence of adverse reaction（17.5%） in group E was obviously lower than that of in group G（37.5%）（P〈0.05）. Conclusion The application of combined spinal-epidural anesthesia in the aged receiving total hip arthroplasty could effectively decrease cognitive dysfunction postoperative compared with the application of general anesthesia.

关 键 词：麻醉方式 老年 全髋关节置换术 术后认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]