不同麻醉方式对老年骨折患者术后认知功能的影响探讨  

Influence of different anesthesia methods on postoperative cognitive function in elderly patients with fractures

作　　者：王跃 WANG Yue(Gaizhou Central Hospital,Gaizhou 115200,China)

机构地区：[1]盖州市中心医院麻醉科,115200

出　　处：《中国实用医药》2023年第15期24-27,共4页China Practical Medicine

摘　　要：目的 分析全身麻醉和腰硬联合麻醉对老年骨折患者术后认知功能的影响。方法 160例接受手术治疗的老年骨折患者,随机分为实验组和对照组,每组80例。对照组患者采用全身麻醉,实验组患者采用腰硬联合麻醉。比较两组患者手术前后血流动力学指标[心率(HR)、平均动脉压(MAP)]、认知功能[简易智力状态检查量表(MMSE)评分]及血清丙二醛(MDA)、超氧化物歧化酶(SOD)水平,术后认知功能障碍(POCD)发生率。结果 术后30 min,实验组患者MAP(78.60±8.65)mm Hg(1 mm Hg=0.133 kPa)高于对照组的(76.04±7.34)mm Hg,差异具有统计学意义(P<0.05);实验组HR略低于对照组,但差异无统计学意义(P>0.05)。术后24、48 h,两组患者MMSE评分均低于本组术前24 h,差异具有统计学意义(P<0.05)。术前24 h、术后48 h,两组患者MMSE评分比较差异无统计学意义(P>0.05);术后24 h,实验组患者MMSE评分(25.300±1.391)分高于对照组的(24.850±1.233)分,差异具有统计学意义(P<0.05)。术后24 h,实验组患者POCD发生率为8.75%,低于对照组的13.75%,但差异无统计学意义(P>0.05)。术后48 h,两组患者POCD均恢复。术后24 h,两组患者血清MDA水平较本组术前24 h升高, SOD水平较本组术前24 h下降,但实验组患者血清MDA水平(8.38±1.54)nmol/ml低于对照组的(10.22±2.18)nmol/ml, SOD水平(88.01±16.63)U/ml高于对照组的(75.38±18.39)U/ml,差异具有统计学意义(P<0.05)。结论 腰硬联合麻醉相比全身麻醉对老年骨折患者麻醉后血流动力学的影响较小,且能够降低机体的氧化应激水平,保护神经元,减少患者认知功能的氧化损伤,降低POCD发生率。Objective To analyze the influence of different anesthesia methods on postoperative cognitive function in elderly patients with fractures.Methods A total of 160 elderly patients with fracture receiving surgical treatment were randomly divided into experimental group and control group,with 80 cases in each group.The control group was given general anesthesia,and the experimental group was given combined spinal-epidural anesthesia.Both groups were compared in terms of hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)],cognitive function[Mini-Mental State Examination(MMSE)score],serum malondialdehyde(MDA)and superoxide dismutase(SOD)levels,and the incidence of postoperative cognitive dysfunction(POCD).Results 30 min after surgery,MAP of(78.60±8.65)mm Hg(1 mm Hg=0.133 kPa)in the experimental group was higher than that of(76.04±7.34)mm Hg in the control group,and the difference was statistically significant(P<0.05).HR of the experimental group was slightly lower than that of the control group,but the difference was not statistically significant(P>0.05).24 and 48 h after surgery,MMSE scores in both groups were lower than those in this group 24 h before surgery,and the difference was statistically significant(P<0.05).24 h before surgery and 48 h after surgery,there was no statistically significant difference in MMSE scores between the two groups(P>0.05).24 h after surgery,MMSE score of(25.300±1.391)points in the experimental group was higher than that of(24.850±1.233)points in the control group,and the difference was statistically significant(P<0.05).24 h after surgery,the incidence of POCD in the experimental group was 8.75%,which was lower than that of 13.75%in the control group,but the difference was not statistically significant(P>0.05).POCD recovered in both groups at 48 h after surgery.24 h after surgery,the serum MDA level of the two groups was higher than that of this group 24 h before surgery,and the SOD level was lower than that of this group before surgery;but the serum MDA level of(8.38±1.5

关 键 词：全身麻醉 腰硬联合麻醉 术后认知 氧化应激 

分 类 号：R614[医药卫生—麻醉学]