老年下肢骨折患者行全身麻醉和腰硬联合麻醉的效果及对术后认知功能的影响  

Effect of general anesthesia and combined spinal-epidural anesthesia in elderly patients with lower extremity fractures and the influence on cognitive function

作　　者：张景田 周维纲[2] ZHANG Jing-tian;ZHOU Wei-gang(the People's Hospital of Shanyang County,Shangluo 726400;Hanzhong Central Hospital,Hanzhong 723000,China)

机构地区：[1]山阳县人民医院,陕西商洛726400 [2]汉中市中心医院,陕西汉中723000

出　　处：《临床医学研究与实践》2019年第30期76-78,共3页Clinical Research and Practice

摘　　要：目的比较全身麻醉与腰硬联合麻醉对老年下肢骨折的麻醉效果及对术后认知功能的影响。方法选取我院2017年1月至2018年6月收治的96例老年下肢骨折患者为研究对象,根据术前会诊及患者、家属选择的麻醉方案将患者分为对照组(48例,全身麻醉)与观察组(48例,腰硬联合麻醉)。对比两组的麻醉效果、生命体征、疼痛评分、术后认知功能评分及不良反应发生情况。结果观察组的麻醉药物用量少于对照组,麻醉起效时间及术后清醒时间短于对照组(P<0.05)。观察组手术开始后15 min及手术结束前10 min的DBP、SBP、HR、RR较麻醉前无显著改变(P>0.05),观察组患者的生命体征较对照组更加稳定。术后3、7、15 d,观察组的VAS评分均低于对照组,MoCA评分显著高于对照组(P<0.05);观察组的不良反应总发生率显著低于对照组(P<0.05)。结论老年下肢骨折患者采用腰硬联合麻醉效果更好,有助于稳定术中生命体征,减少不良反应,同时能减轻疼痛和认知功能障碍,值得临床推广与应用。Objective To explore the effect of general anesthesia and combined spinal-epidural anesthesia in elderly patients with lower extremity fractures and the influence on cognitive function.Methods Ninety-six elderly patients with lower extremity fractures admitted in our hospital from January 2017 to June 2018 were selected as the research objects.According to preoperative consultation and anesthesia scheme selected by patients and their families,the patients were divided into control group(48 cases,general anesthesia)and observation group(48 cases,combined spinal-epidural anesthesia).The anesthesia effects,vital signs,the scores of pain and postoperative cognitive function and adverse reactions were compared between the two groups.Results The dosage of anesthesia drugs in the observation group was less than that in the control group,the onset time of anesthesia and the waking time after operation were shorter than those in the control group(P<0.05).There were no significant changes in DBP,SBP,HR and RR of the observation group at 15 minutes after operation onset and 10 minutes before the end of operation than those before anesthesia(P>0.05);the vital signs of the observation group were more stable than those of the control group.At the 3rd,7th and 15th day after operation,the VAS scores of the observation group were lower than those of the control group,and the MoCA scores were significantly higher than those of the control group(P<0.05).The total incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion The combined spinal-epidural anesthesia applied to elderly patients with lower extremity fractures can get good effect.It is helpful to stabilize intraoperative vital signs,reduce adverse reactions,and reduce pain and cognitive dysfunction,which is worthy of clinical promotion and application.

关 键 词：全身麻醉 腰硬联合麻醉 下肢骨折 认知功能 生命体征 

分 类 号：R614[医药卫生—麻醉学]