全麻和腰硬联合麻醉对老年下肢骨折手术患者循环功能、认知功能及疼痛的影响  

Effects of General Anesthesia and Combined Spinal-epidural Anesthesia on Circulatory Function,Cognitive Function and Pain in Elderly Patients with Surgery for Lower Extremity Fracture

作　　者：李亚东[1] 张侃[1] LI Ya-dong;ZHANG Kan(Department of Anesthesiology,People's Hospital of Yan'an City,Yan'an,Shaanxi 716000,China)

机构地区：[1]延安市人民医院麻醉科

出　　处：《解放军医药杂志》2020年第1期102-105,109,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：陕西省科技计划项目(2019ZP07335)

摘　　要：目的比较全麻(GA)和腰硬联合麻醉(CSEA)对老年下肢骨折手术患者循环功能、认知功能及疼痛的影响。方法回顾性分析2016年11月—2018年11月我院收治的老年下肢骨折手术患者96例的临床资料,根据麻醉方式分为CSEA组52例和GA组44例。观察2组术前(T1)、麻醉10 min(T2)、30 min(T3)时循环功能指标水平,评估T1、术后6 h(T4)、术后24 h(T5)时认知功能和谵妄发生情况,检测血清神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平。记录2组术后24 h内认知功能障碍(POCD)、谵妄发生情况。观察2组手术情况和患者术后疼痛情况。结果2组T2~T3时点心率、收缩压、舒张压均低于T1时点,但CSEA组高于GA组(P<0.05)。2组简易智力状态量表评分于T4时点降低,于T5时点升高,但均低于T1时点,CSEA组高于GA组(P<0.05);2组谵妄量表评分于T4时点升高,于T5时点降低,但均高于T1时点,CSEA组低于GA组(P<0.05)。CSEA组术后24 h POCD和谵妄发生率均低于GA组(P<0.05)。2组血清NGF、BDNF水平均于T4时点降低,于T5时点升高,但均低于T1时点,CSEA组高于同时间GA组(P<0.05)。2组手术情况、术后VAS评分比较差异无统计学意义(P>0.05)。结论CSEA用于老年下肢骨折手术患者循环波动较小,并可减轻麻醉对患者术后认知功能和谵妄的影响,手术情况及术后疼痛程度改善良好。Objective To compare effects of general anesthesia(GA)and combined spinal-epidural anesthesia(CSEA)on circulatory function,cognitive function and pain in elderly patients with surgery for lower extremity fracture.Methods Clinical data of 96 elderly patients with surgery for lower extremity fracture admitted during November 2016 and November 2018 was retrospectively analyzed,and the patients were divided into CSEA group(n=52)and GA group(n=44)according to anesthesia methods.Levels of circulatory function indexes were compared before surgery(T1),at 10 min(T2)and 30 min(T3)of anesthesia,and cognitive function and incidence rate of delirium at T1,at 6h(T4)and at 24h(T5)after operation were evaluated,and levels of serum nerve growth factor(NGF)and brain-derived neurotrophic factor(BDNF)were detected in two groups.Incidence rate of postoperative cognitive dysfunction(POCD)and delirium within 24 h after surgery were recorded in the two groups.Conditions of surgery and postoperative pain were observed in two groups.Results Values of heart rate,systolic blood pressure and diastolic blood pressure at T2-T3 were significantly lower than those at T1 in two groups,but the vales in CSEA group were significantly higher than those in GA group(P<0.05).Mini-mental state examination(MMSE)scores were decreased at T4 and increased at T5,but the scores were all lower than those at T1 in two groups,and the scores in CSEA group were significantly higher than those in GA group(P<0.05).Confusion assessment method(CAM)scores were increased at T4 and decreased at T5,but the scores were all higher than those at T1 in two groups,and the scores in CSEA group were lower than those in GA group(P<0.05).Incidence rates of POCD and delirium in CSEA group were significantly lower than those in GA group(P<0.05).Levels of NGF and BDNF were decreased at T4 and increased at T5,but the levels were all lower than those T1 in two groups,and the levels in CSEA group were significantly higher than those in GA group at the same time(P<0.05).There were no sign

关 键 词：骨折 下肢 麻醉 全身 腰硬联合麻醉 神经生长因子 脑源性神经营养因子 认知障碍 老年人 

分 类 号：R683.42[医药卫生—骨科学]