不同麻醉及术后镇痛方式对老年股骨骨折患者术后早期认知功能的影响  

Effect of Different Methods of Anesthesia and Postoperative Analgesia on Postoperative Early Cognitive Function in Elderly Patients with Femoral Fractures

作　　者：张玫[1] 马中原[1] 周愚[1] 梁根强 乔瑞冬[1] ZHANG Mei MA Zhong-yuan ZHOU Yu LIANG Gen-qiang QIAO Rui-dong(Department of Anesthesia, Peopleg Hospital of Zhuhai, Zhuhai, Guangdong 519000, China)

机构地区：[1]珠海市人民医院麻醉科,广东珠海519000

出　　处：《临床误诊误治》2016年第10期97-100,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的比较不同麻醉及术后镇痛方式对于老年股骨骨折患者术后早期认知功能的影响。方法选取择期行手术治疗的老年股骨颈或股骨粗隆骨折患者75例,根据麻醉及术后镇痛方式的不同均分为静脉全身麻醉组(GA组)、腰硬联合麻醉组(CSEA组)和神经阻滞组(NB组)。GA组给予静脉全身麻醉及术后静脉镇痛泵镇痛,CSEA组给予腰硬联合麻醉及术后硬膜外自控镇痛,NB组给予腰丛神经、坐骨神经阻滞及术后腰丛神经自控镇痛。观察并记录各组术后6、12、24、48 h疼痛视觉模拟评分(visual analogue scale,VAS),术前和术后1、3、7 d简易智力状态检查量表(MMSE)评分,以及术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生情况。结果 CSEA组、NB组术后6、12、24、48 h VAS评分均低于GA组(P<0.05或P<0.01);术后1 d MMSE评分NB组>CSEA组>GA组,差异均有统计学意义(P<0.05);术后3 d MMSE评分,NB组>CSEA组和GA组,差异有统计学意义(P<0.05);3组术后1 d MMSE评分与麻醉前比较明显降低(P<0.05)。术后1、3 d NB组POCD发生率均低于其他两组,差异均有统计学意义(P<0.05或P<0.01);且术后1 d GA组POCD发生率高于CSEA组(P<0.05);术后7 d 3组均无POCD发生。结论老年股骨手术患者全身麻醉较其他麻醉方式有更高的早期POCD发生率,神经阻滞可能是老年股骨手术更为安全、有效的麻醉和术后镇痛方式。Objective To compare effects of different methods of anesthesia and postoperative analgesia on postoperative early cognitive function in elderly patients with femoral fractures. Methods A total of 75 elderly patients with femoral neck or femoral troehanter fractures undergoing surgical treatment were divided into intravenous general anesthesia （GA） group combined spinal epidural anesthesia （CSEA） group and nerve block （NB） group according to anesthesia and postoperative analgesia methods. GA group was given intravenous general anesthesia and postoperative analgesia of intravenous analgesia pump; CSEA group was given CSEA and postoperative epidural self-controlled analgesia; NB group was given block of lumbar plexus and sciatic nerve and postoperative lumbar plexus nerve self-controlled analgesia. Among three groups, visual analogue scale （VAS） scores on postoperative 6^th , 12^th , 24^th and 48^th h, mini-mental state examination （MMSE） scores before surgery and at postoperative 1^st, 3^rd 7^th d and incidence rates of postoperative cognitive dysfunction （POCD） were also recorded. Results VAS scores on postoperative 6^th , 12^th , 24^th and 48^th in CSEA and NB groups were lower than that in GA group （P 〈 0. 05 or P 〈0. 01 ）. MMSE scores at postoperative 1^st d from high to low were NB group, CSEA group and GA group, and the differences were statistically significant （P 〈 0.05） ; MMSE scores at postoperative 3^rd d in NB group was higher than those in CSEA and GA groups, and the differences were statistically significant （P 〈 0. 05）. Among three groups, MMSE scores at postoperative 1^st d were significantly decreased compared with those before anesthesia （ P 〈 0.05 ） ; incidence rates of POCD at postoperative 1^st and 3^rd d in NB group were lower than other two groups, and the differences were statistically significant （ P 〈 0.05 or P 〈 0.01 ） ; the rate at postoperative 1^st d in GA group was higher than that in CSEA group （ P 〈 0.05 ） ; no POCD pa

关 键 词：麻醉 全身 麻醉和镇痛 股骨骨折 外科手术 认知障碍 老年人 

分 类 号：R614[医药卫生—麻醉学] R683.42[医药卫生—外科学]