| 刘 丽,徐 冰,唐 鸣,巩文怡,顾国清.麻醉方式对老年髋关节置换术患者的影响[J].,2018,(7):1297-1301 |
| 麻醉方式对老年髋关节置换术患者的影响 |
| Effect of Different Anesthesia Modes on the Elderly Patients Undergoing Hip Replacement |
| 投稿时间：2017-09-25 修订日期：2017-10-22 |
| DOI：10.13241/j.cnki.pmb.2018.07.020 |
| 中文关键词: 髋关节置换术 腰硬联合麻醉 全麻 术后认知功能障碍 |
| 英文关键词: Hip replacement Combined spinal and epidural anesthesia General anesthesia Postoperative cognitive dysfunction |
| 基金项目:上海市宝山区科技创新专项资金项目（16-E-5) |
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| 中文摘要: |
| 摘要 目的：观察和比较腰硬联合麻醉与全麻对行择期髋关节置换术老年患者的生命体征、简易智力状况检查量表(Mini-mental State Examinatlon，MMSE)评分、认知功能障碍(postoperative cognitive dysfunction，POCD)发生率的影响。方法：选取2015年1月-2017年6月于我院行择期髋关节置换术的80例老年患者为研究对象，随机分为腰硬联合麻醉组和全麻组，每组各40例。全麻组患者术前应用全身麻醉，腰硬联合麻醉组患者术前应用腰硬联合麻醉。观察两组患者麻醉前后的生命体征、MMSE评分变化及POCD的发生情况。结果：腰硬联合麻醉组患者麻醉后收缩压(Systolic pressure，SP)、舒张压(diastolic pressure，DP)、心率(heart rate，HR)、呼吸频率(Respiratory rate，RR)均低于全麻组(P＜0.05)，两组患者血氧饱和度(Pulse Oxygen Saturation，SpO2)比较差异无统计学意义(P＞0.05)。腰硬联合麻醉组患者麻醉起效时间、运动阻滞恢复时间以及麻醉药用量均低于全麻组(P＜0.05)。术后6 h、24 h、72 h，腰硬联合麻醉组的MMSE评分均高于全麻组患者(P＜0.05)。术后1 d，全麻组的患者出现19例POCD，腰硬联合麻醉组出现4例，发生率显著低于全麻组(P＜0.05)；两组在术后3 d的POCD发生率比较差异无统计学意义(P＞0.05)。结论：腰硬联合麻醉用于择期行髋关节置换术的老年患者具有良好的临床效果，麻醉起效快，缩短了完全阻滞时间，明显改善了患者的生命体征，降低术后认知功能障碍的发生，麻醉药物用量少。 |
| 英文摘要: |
| ABSTRACT Objective: To observe and compare the effect of combined spinal epidural anesthesia and general anesthesia on the vital signs, simple mental state examination scale (MMSE) score and the incidence of postoperative cognitive dysfunction (PPCD) in elderly patients undergoing elective hip replacement. Methods: 80 cases of patients who underwent elective hip arthroplasty in our hospital were selected as the research object from January 2015 to June 2017. According to the random number table method, 80 patients were divided into epidural anesthesia group and general anesthesia group, 40 cases in each group. Patients in general anesthesia group were given gen- eral anesthesia before operation. And combined spinal epidural anesthesia was applied to patients under combined spinal epidural anes- thesia. The vital signs, MMSE score and POCD were observed amd compared between two groups. Results: The Systolic pressure (SP), diastolic pressure (DP), heart rate (HR) and respiratory rate (RR) of combined spinal epidural anesthesia group were lower than those in the general anesthesia group (P<0.05). There was no significant difference in the pulse oxygen saturation (SpO2) between the two groups (P>0.05). The BP, DP, HR and RR in the combined spinal epidural anesthesia group were better than those in the general anesthesia group (P<0.05), and there was no significant difference between the two groups in the SpO2(P>0.05). The time of onset of anesthesia, the time of motor block recovery and the amount of anesthetic used in the combined spinal epidural anesthesia group were lower than those in the general anesthesia group (P<0.05). There was no significant difference in the MMSE score between the two groups before anesthe- sia (P>0.05). The scores of MMSE at 6, 24 and 72 h in combined spinal epidural anesthesia group were higher than those in the general anesthesia group(P<0.05). There were 19 cases of POCD in the general anesthesia group at 1 day after operation, and 4 cases in the lum- bar epidural combined anesthesia group (P<0.05). There was no significant difference in the incidence of POCD between the two groups in the three days after operation (P>0.05). Conclusion: Combined spinal epidural anesthesia had good clinical effect on the elderly patients undergoing hip arthroplasty, it could shorten the complete block time, significantly improve the patient's vital signs, reduce the inci- dence of postoperative cognitive dysfunction and the dose of anesthetic drugs. |
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