摘要
目的探讨不同麻醉方法对老年骨科大手术患者效果以及术后早期认知功能的影响.方法将176例老年骨科大手术患者采用随机数字表法分为观察组和对照组,每组88例,观察组采用硬膜外麻醉,对照组采用全身麻醉.比较两组患者手术时间、麻醉时间和麻醉前、术中、术后生命体征变化,术中出血量、输液量、尿量、视觉疼痛评分,术后麻醉恢复情况(睁眼时间、应答时间);统计分析两组术后深静脉血栓形成、肺栓塞、肺炎、恶心呕吐发生率及死亡率;于手术前后采用简易智能量表评定两组认知功能.结果麻醉后即刻两组收缩压、舒张压、血氧饱和度水平均较麻醉前显著下降(P<0.01),观察组显著高于对照组(P<0.01),两组心率虽较麻醉前有所下降,但差异无统计学意义(P>0.05).观察组术中出血量、输血量、输液量、尿量与对照组比较差异无统计学意义(P>0.05),视觉疼痛评分显著高于对照组(P<0.01),手术时间、麻醉时间、术后睁眼时间、应答时间显著短于对照组(P<0.01);术后观察组深静脉血栓形成、肺栓塞、肺炎发生率显著低于对照组(P<0.01);术后第1d、2d、3d、7d,观察组简易智能量表评分显著高于对照组(P<0.01);术后第1d、2d、3d观察组认知功能障碍发生率显著低于对照组(P<0.01),但术后第7 d与对照组比较差异无统计学意义(P>0.05).结论不同麻醉方法在老年骨科大手术中各具优势,麻醉方法的选择应根据患者耐受程度、术中管理难度以及术后并发症控制等因素,综合评价后进行个体化差异选择,方能达到理想麻醉效果,降低麻醉风险.
Objective To study the effect of different anesthesia methods on early postoperative cognitive function in elderly patients undergoing major orthopaedic surgery.Methods 176 elderly patients undergoing major orthopedic surgery were selected and randomly divided into the observation group and the control group,88 cases in each group.The observation group was given epidural anesthesia,and the control group was given general anesthesia.The operation time,anesthesia time and pre-anesthesia,intraoperative and postoperative vital signs,intraoperative blood loss,infusion volume,urine volume,visual pain score,postoperative anesthesia recovery(blink time,response time)were compared between the two groups.The postoperative deep vein thrombosis,pulmonary embolism,pneumonia,incidence of nausea and vomiting and mortality of the two groups were compared.The cognitive functions of the two groups were assessed using MMSE before and after surgery.Results Immediately after anesthesia,the systolic blood pressure,diastolic blood pressure,and oxygen saturation levels of the two groups were significantly lower than those before anesthesia(P<0.01),and the observation group was significantly higher than the control group(P<0.01).Although the heart rate of the two groups decreased compared with that before anesthesia,the difference was not statistically significant(P>0.05).There was no significant difference in the amount of blood loss,blood transfusion,infusion volume and urine volume between the observationgroup and the control group(P>0.05).The visual pain score was significantly higher than that of the control group(P<0.01).The operation time,anesthesia time,postoperative blink time and response time were significantly shorter than those of the control group(P<0.01).The incidence of deep vein thrombosis,pulmonary embolism and pneumonia in the observation group was significantly lower than that in the control group(P<0.01).On the 1st,2nd,3rd and 7th postoperative day,the score of MMSE in the observation group was significantly higher than that in the control group(P<0.01).On the 1st,2nd,3rd postoperative day,the incidence of cognitive dysfunction in the observation group was significantly lower than that in the control group(P<0.01).While on the 7th postoperative day,there was no significant difference compared with the control group(P>0.05).Conclusion Different methods of anesthesia in orthopedic surgery in the elderly have their own advantages,the choice of anesthesia should be based on patient tolerance,intraoperative management difficulties and postoperative complications control.Individualized difference selection after comprehensive evaluation can achieve ideal anesthesia effect and reduce the risk of anesthesia.
作者
张立群
陈祖涛
韩俊
Zhang Liqun;Chen Zutao;Han Jun(General Hospital of Pingma Shenma Medical Group,Pingdingshan 467000,Henan,China)
出处
《临床心身疾病杂志》
CAS
2019年第2期80-85,共6页
Journal of Clinical Psychosomatic Diseases
