摘要
目的 观察全身麻醉复合硬膜外麻醉对老年骨科患者术后认知功能的影响.方法 将2011年1月～2012年1月64例行骨科手术的60岁以上老年患者作为观察对象,全部入选病例随机分为Ⅰ组（全身麻醉）和Ⅱ组（全身麻醉复合硬膜外麻醉）,每组各32例,比较两组患者麻醉前、术中及术后的SBP、DBP、HR的变化情况以及两组患者麻醉前和术后6h、12h、24 h MMSE评分的变化情况,比较两组患者麻醉恢复情况,包括睁眼时间、拔管时间、应答时间.结果 Ⅰ组和Ⅱ组患者术中、术后SBP虽然较麻醉前降低,但组间比较差异不显著（P＞0.05）.且Ⅰ组与Ⅱ组患者对应时间点比较,差异也不显著（P＞0.05）.Ⅰ组与Ⅱ组的DBP、HR麻醉前、麻醉中及麻醉后进行组间及组内比较,差异均不显著（P＞0.05）.Ⅰ组与Ⅱ组麻醉前MMSE评分比较,差异不显著（P＞0.05）.术后6h,Ⅰ组与Ⅱ组MMSE评分分别较麻醉前明显降低,且Ⅰ组与Ⅱ组此时点MMSE评分组间比较,差异具有显著性（P＜0.05）.术后12h,Ⅰ组与Ⅱ组MMSE评分分别较麻醉前及术后6h也明显降低,且Ⅰ组与Ⅱ组此时点MMSE评分组间比较,差异具有显著性（P＜0.05）.术后24h,Ⅰ组与Ⅱ组MMSE评分分别较麻醉前降低,且Ⅰ组较Ⅱ组降低更显著,差异具有显著性（P＜0.05）.Ⅱ组患者睁眼时间明显快于Ⅰ组,组间比较,差异具有显著性（P＜0.05）.Ⅱ组患者的拔管时间明显短于Ⅰ组,组间比较,差异具有显著性（P＜0.05）.Ⅱ组患者的应答时间明显快于Ⅰ组,组间比较,差异具有显著性（P＜0.05）.结论 全身麻醉复合硬膜外麻醉对老年骨科患者术后认知功能的影响较小,且保持血流动力学稳定,麻醉恢复效果好,是一种适合老年骨折患者首选的麻醉方法,值得推广和应用.
Objective To observe the effect of general anesthesia combined with epidural anesthesia on postoperative cognitive function in elderly orthopedic. Methods All enrolled patients from January 2011 to January 2012 were ran- domly divided into group I （general anesthesia）and group Ⅱ （general anesthesia combined with epidural anesthesia）, 32 cases in each group,SBP,DBP, HR changes and 6 h,12 h,24 h MMSE score changes,and complication were com- pared between two groups. Results I group and the group Ⅱ postoperative SBP although were lowered than before anes- thesia, but the difference was not significant （P〉0.05）, the corresponding time points of two groups had no significant difference （P〉0.05）.Group I and Group II of DBP,HR before anesthesia,anesthesia and anesthesia,the difference was not significant（P〉0.05）. MMSE score in Group I and Group Ⅱ before anesthesia, the difference was not significant（P〉 0.05）.After 6 h, MMSE in I group and Group Ⅱ scores were significantly lower than before anesthesia, and the group I and group Ⅱ at this time point MMSE scores,the difference was significant （P〈O.05）After 12 h, I group and Group Ⅱ respec- tively,compared with the MMSE score before and 6 h after anesthesia was significantly reduced,and the difference of the group I and group Ⅱ at this time point MMSE scores was significant（P 〈0.05）. After 24 h, I group and Group Ⅱ MMSE scores were lower than the pre-anesthesia,and the I group decreased more significantly than in group Ⅱ （P〈0.05）. Group Ⅱ patients was significantly faster than the eyes in group I between the two groups （P〈0.05）.Group Ⅱ patients with extubation time was significantly shorter than group I with significant difference （P〈0.05）.Group Ⅱ patients was significantly faster than the response time of group I （P〈0.05）. Conclusion General anesthesia combined with epidural anesthesia on cognitive function in elderly orthopedic patients less affected, and to maintain hemodynamic st
出处
《中国现代医生》
2013年第32期104-106,共3页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2012KYB046)
关键词
骨科患者
老年
全身麻醉
硬膜外麻醉
认知功能
Orthopedic patients
Elderly
General anesthesia
Epidural anesthesia
Cognitive function
