摘要
目的观察全麻与腰硬联合麻醉对老年全膝关节置换术后精神状态、深静脉血栓发生率的影响。方法选取南通市第一人民医院2015年5月—2016年5月择期行全膝关节置换术的老年患者120例,根据麻醉方式不同分为全身麻醉组(全麻组)和腰硬联合麻醉组(腰硬麻组),每组60例。分别于术前和术后12、24、48、72 h对两组进行简易精神状态检查量表(MMSE)评分及神经营养因子(BDNF)和神经生长因子(NGF)水平检测;统计两组术后精神错乱发生率及深静脉血栓发生率。结果术后两组MMSE评分及BDNF、NGF水平较术前显著降低(P<0.05);术后12、24、48、72 h,全麻组MMSE评分及BDNF和NGF水平显著低于腰硬麻组(P<0.05);术后全麻组精神错乱发生率及深静脉血栓发生率显著高于腰硬麻组(P<0.05)。结论腰硬麻对老年下肢手术患者术后精神状态及深静脉血栓发生率的影响显著低于全麻,为老年下肢手术患者麻醉方式的选取提供了理论依据。
Objective To investigate effects of general anesthesia（ GA） and combined spinal epidural anesthesia（ CSEA） on mental status and incidence rate of deep venous thrombosis（ DVT） in elderly patients after total knee arthroplasty. Methods A total of 120 elderly patients with selectively total knee arthroplasty during May 2015 and May2017 were divided into GA group（ n = 60） and CSEA group（ n = 60） according to anaesthetic ways. Mini-mental state examination（ MMSE） was performed before surgery and at the 12 thh,24 thh,48 thh and 72 thh after surgery,and levels of brain-derived neurotrophic factor（ BDNF） and nerve growth factor（ NGF） in peripheral blood were detected,and then incidence rates of postoperative delirium and DVT were recorded in two groups. Results MMSE scores,BNDF and NGF levels in peripheral blood were significantly decreased after surgery compared with those before surgery（ P〈0. 05）. In GA group,MMSE scores,BNDF and NGF levels in peripheral blood at the 12 thh,24 thh,48 thh and 72 thh after surgery were significantly lower（ P〈0. 05）,and incidence rates of postoperative delirium and DVT were significantly higher than those CSEA group（ P〈0. 05）. Conclusion Effects of CSEA cognitive function,mental status and incidence rate of DVT in elderly patients after total knee arthroplasty are significantly less than those by general anesthesia,which is helpful in selection of anaesthetic ways in elderly patients with lower extremity surgery.
作者
康春艳
朱建炜
KANG Chun-yan;ZHU Jian-wei(Operation Room,the First People＇s Hospital of Nantong,Nantong,Jiangsu 226000,China;Department of Osteology,Affiliated Hospital of Nantong University,Nantong,Jiangsu 226000,China)
出处
《解放军医药杂志》
CAS
2018年第5期58-61,共4页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
江苏省卫生计生委面上科研课题(H201524)
关键词
全膝关节置换术
麻醉
全身
麻醉
硬膜外
精神状态
静脉血栓形成
Total knee arthroplasty
Anesthesia
general
Anesthesia
epidural
Mental status
Venous thrombosis
