腰骶丛阻滞与全身麻醉对老年髋部骨折手术患者术后谵妄、认知障碍和预后的影响  

The influence of lumbosacral plexus block and general anesthesia on postoperative delirium,cognitive impairment and prognosis in elderly patients with hip fracture surgery

作　　者：李随花[1] 唐洪涛[1] 马文龙[1] 李明亮 赵敏 LI Suihua;TANG Hongtao;MA Wenlon(Luoyang Orthopedic Hospital in Henan Province,Luoyang 471002,China)

机构地区：[1]河南省洛阳正骨医院,洛阳471002 [2]河南科技大学第五附属医院

出　　处：《国际精神病学杂志》2019年第4期703-706,共4页Journal Of International Psychiatry

摘　　要：目的探讨腰骶丛阻滞与全身麻醉对老年髋部骨折手术患者术后谵妄、认知障碍和预后的影响。方法选取2017年6月~2018年1月在我院就诊的老年髋部骨折患者146例,采用随机数表法分为对照组(73例)与观察组(73例),观察组使用腰骶丛阻滞麻醉,对照组使用全身麻醉,比较两组手术及麻醉效果、术后认知障碍、谵妄发生情况及麻醉相关不良反应,并对比两组1年内死亡情况。结果两组在手术时间及术中出血量上无明显差异(P>0.05),观察组在麻醉时间、睁眼时间、拔管时间及应答时间上显著少于对照组(P<0.05);术前两组简易智力状态检查量表(MMSE)评分无明显差异(P>0.05),术后两组患者评分均显著下降,其中观察组在术后12h、术后1d、术后7d、术后28d的评分显著高于对照组(P<0.05);观察组发生谵妄人数显著少于对照组(P=0.021),谵妄持续时间、首次谵妄评定量表(DRS)及末次DRS评分显著小于对照组(P<0.05);观察组发生尿储留及低血压的人数显著少于对照组(P<0.05);对照组死亡风险显著高于观察组(P=0.032)。结论腰骶丛阻滞可降低老年髋部骨折术后认知障碍、谵妄的发生情况,并提高患者预后。Objective To explore the influence of lumbosacral plexus block and general anesthesia on postoperative delirium,cognitive impairment and prognosis of elderly patients with hip fracture surgery. Method From June 2017 to January 2018,146 cases of elderly patients with hip fracture in our hospital were divided into control group(73 cases)and the observation group(73 cases),the patients in observation group were treated by the lumbosacral plexus block anesthesia,while the control group by general anesthesia, The effect of surgery and anesthesia,postoperative cognitive dysfunction,delirium occurrence and related adverse reactions to anesthesia and rate of death within 1 year were compared between two groups. Results There was no significant difference between the two groups in operation time and intraoperative blood loss(P>0.05). The observation group had significantly less anesthesia time,eye opening time,extubation time and response time than the control group(P<0.05). There was no significant difference in preoperative mini-mental state examination(MMSE)score between the two groups(P>0.05),and postoperative scores of the two groups were significantly decreased,and the scores of the observation group at 12 h,1 d,7 d and 28 d after surgery were significantly higher than control group(P<0.05). The number of delirium in the observation group was significantly lower than control group(P=0.021),duration of delirium,first delirium rating scale(DRS)and last DRS score were significantly lower than control group(P<0.05). The number of urine retention and hypotension in the observation group was significantly lower than control group(P<0.05). The risk of death in the control group was significantly higher than that in the observation group(P=0.032). Conclusions Lumbosacral plexus block can effectively reduce postoperative cognitive impairment,delirium and prognosis of elderly patients with hip fractures.

关 键 词：腰骶丛阻滞 认知障碍 谵妄 老年患者 髋部骨折 

分 类 号：R749.99[医药卫生—神经病学与精神病学]