Effect of epidural block combined with general anesthesia on early postoperative cognitive function in elderly patients with hip fracture
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摘要: 目的 探讨老年患者髋部周围骨折术采用硬脊膜外腔阻滞加全身麻醉方法对术后早期认知功能的影响。 方法 抽取2012年2月-2016年2月在绍兴市中心医院拟择期行手术治疗的老年髋部周围骨折患者88例作为研究对象,按年龄、文化程度分层,按照随机数字表法随机分为观察组和对照组,各44例。观察组给予硬脊膜外腔阻滞加全身麻醉方法,对照组给予全身麻醉方法,对比分析2组麻醉效果及认知功能障碍的发生率。 结果 2组患者术前、术中、术后血流动力学指标收缩压(SBP)、舒张压(DBP)、心率(HR)变化差异无统计学意义(P>0.05),2组患者血流动力学指标SBP、DBP、HR在不同时间点的效应差异无统计学意义(P>0.05),观察组术后3 h、6 h、24 h、3 d的MMSE评分优于对照组(P<0.05),观察组术后3 h、6 h、24 h及3 d的认知功能障碍发生率均明显低于对照组(P<0.05),观察组患者睁眼时间[(12.3±3.5) min]、拔管时间[(13.5±3.1)min]、应答时间[(15.3±4.4) min]均快于对照组[(17.4±2.8) min、(20.4±2.8) min、(20.8±4.1) min,P<0.05]。 结论 老年患者髋部周围骨折术中使用全身麻醉加硬膜外麻醉方法具有较好的临床效果,对患者血流动力学稳定性影响小,术后麻醉恢复良好,对认知功能影响小,具有重要的应用价值。
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关键词:
- 硬脊膜外腔阻滞 /
- 全身麻醉 /
- 老年患者髋部周围骨折术 /
- 认知功能
Abstract: Objective To investigate the effects of epidural block combined with general anesthesia on early postoperative cognitive function in elderly patients with hip fracture. Methods From February,2012 to February,2016,88 cases of elderly patients with hip fracture were selected as the study subjects.According to the age and educational level,the patients were randomly divided into the observation group and the control group,with 44 cases in each group.The observation group received epidural block and general anesthesia,while the control group was given general anesthesia,and the effect of the two groups were compared and analyzed. Results There was no significant difference in HR,DBP and SBP between the two groups before,during and after the operation (P>0.05).There was no statistical significance in effects of hemodynamic indexes (SBP,DBP,HR) at different time points (P>0.05).The postoperative MMSE scores at the time of 6,24 h,3 days and 7 days after the operation in the observation group were better than those in the control group (P<0.05);The incidence of cognitive dysfunction at the time of 3,6,24 h and 3 days in the observation group was significantly lower than those of the control group (P<0.05).The post-anesthesia awaking time,time to extubation,and response time were (12.3±3.5) min,(13.5±3.1) min and (15.3±4.4) min in the observation group,which were shorter than (17.4±2.8) min,(20.4±2.8) min and (20.8±4.1) min of the control group,respectively (P<0.05). Conclusion The epidural block combined with general anesthesia for elderly patients with hip fracture surgery has better clinical effect and little influence on hemodynamics parameters;With mild influence on the cognitive function,patients can recover quickly from anesthesia.The wildly application can be tried in clinic.
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