竖脊肌阻滞辅助全身麻醉对老年人腰椎骨折术后认知功能的影响  

Effects of paravertebral muscle block assisted general anesthesia on postoperative cognitive function in older adult patients undergoing lumbar spine fracture surgery

作　　者：张高娇 蒋毅 Zhang Gaojiao;Jiang Yi(Department of Anesthesiology,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine,Wenzhou 325000,Zhejiang Province,China)

机构地区：[1]温州市中西医结合医院麻醉科,温州325000

出　　处：《中国基层医药》2024年第11期1639-1643,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医药卫生科技计划(2023KY1160)。

摘　　要：目的观察竖脊肌阻滞辅助全身麻醉对老年人腰椎骨折术后认知功能的影响。方法回顾性分析温州市中西医结合医院2018年1月至2022年12月手术治疗的老年腰椎骨折患者68例的临床资料,根据麻醉方式不同分为对照组、观察组各34例。对照组采用全身麻醉,观察组采用竖脊肌阻滞辅助全身麻醉。比较两组术中麻醉不良反应、术后镇痛效果及术后认知功能障碍发生情况。结果观察组麻醉不良反应发生率为6%(2/34),明显低于对照组的26%(9/34),差异有统计学意义(χ^(2)=5.31,P=0.022)。与麻醉前比较,术后两组疼痛数字评价量表(NRS)评分均降低,观察组术后24 h、48 h、72 h的NRS评分分别为(2.63±0.42)分、(3.14±0.55)分、(4.35±0.76)分,均低于对照组的(3.52±0.63)分、(4.58±0.71)分、(5.83±0.92)分(t=6.85、9.35、7.23,均P<0.001);观察组术后24 h、48 h、72 h补救镇痛次数分别为(3.42±0.38)次、(5.40±0.72)次、(6.93±1.07)次,均少于对照组的(6.97±0.87)次、(8.26±1.27)次、(10.38±1.36)次(t=21.80、8.78、9.02,均P<0.001)。与麻醉前比较,术后两组简易智力检测量表(MMSE)评分均降低,观察组术后24 h、48 h、72 h的MMSE评分分别为(25.27±1.11)分、(25.06±1.01)分、(27.50±1.23)分,均高于对照组的(19.40±0.84)分、(23.17±0.96)分、(24.60±1.12)分(t=24.59、7.91、10.17,均P<0.001)。结论竖脊肌阻滞辅助全身麻醉能降低老年腰椎骨折患者术中麻醉不良反应发生率,提升术后镇痛效果,降低术后认知功能障碍发生率,安全性高。Objective To investigate the effects of paravertebral muscle block assisted general anesthesia on postoperative cognitive function in older adult patients undergoing lumbar spine fracture surgery.Methods The clinical data of 68 older adult patients with lumbar spine fractures who underwent surgical treatment at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to December 2022 were retrospectively analyzed.The patients were divided into a control group(n=34 cases)and an observation group(n=34 cases)depending on anesthesia methods used.The control group received general anesthesia,while the observation group received paravertebral muscle block assisted general anesthesia.Intraoperative anesthesia-related adverse reactions,postoperative pain relief,and the incidence of postoperative cognitive dysfunction were compared between the two groups.Results The incidence of anesthesia-related adverse reactions in the observation group was 6%(2/34),which was significantly lower than that in the control group[26%(9/34),χ^(2)=5.31,P=0.022].Compared with before anesthesia,the Numerical Rating Scale scores of both groups decreased after surgery.At 24,48,and 72 hours after surgery,the Numerical Rating Scale scores of the observation group were(2.63±0.42)points,(3.14±0.55)points,and(4.35±0.76)points,respectively,which were significantly lower than those of the control group[(3.52±0.63)points,(4.58±0.71)points,(5.83±0.92)points,t=6.85,9.35,7.23,all P<0.001].At 24,48,and 72 hours after surgery,the frequency of rescue analgesia in the observation group was(3.42±0.38),(5.40±0.72),and(6.93±1.07),respectively,which were significantly lower than those in the control group[(6.97±0.87),(8.26±1.27),and(10.38±1.36),t=21.80,8.78,9.02,all P<0.001].Compared with before anesthesia,the Mini-Mental State Examination scores in each group decreased significantly after surgery.At 24,48,and 72 hours after surgery,the Mini-Mental State Examination scores in the observation group were(25.27±1.11)poin

关 键 词：脊柱骨折 麻醉 全身 神经肌肉阻滞 认知功能障碍 疼痛 手术后 老年人 

分 类 号：R614.2[医药卫生—麻醉学]