摘要
目的探讨腰-硬联合麻醉(CSEA)对老年髋部骨折手术患者术后疼痛及短期认知功能的影响。方法回顾性选取2018年10月至2020年9月在聊城市人民医院东昌府院区行髋部骨折手术的60例老年患者为研究对象,按麻醉方法不同分为对照组和观察组,每组30例。对照组行全凭静脉麻醉(TIVA),观察组行CSEA。比较两组术后不同时点疼痛视觉模拟量表(VAS)评分及48 h内镇痛补救率,比较两组不同时点简易精神状态评价量表(MMSE)评分,比较两组术前及术后1 d血清白细胞介素(IL)-6、IL-10及肿瘤坏死因子-α(TNF-α)水平,观察两组术后不良事件发生情况。结果在术后48 h内,观察组镇痛补救率为3.33%(1/30),低于对照组的26.67%(8/30),差异有统计学意义(χ2=6.40,P<0.05)。观察组术后4、6、12、24、48 h VAS评分均低于对照组,差异有统计学意义(P<0.05)。观察组术后1、3 d MMSE评分高于对照组[(25.38±2.86)分比(22.17±2.72)分、(26.89±3.04)分比(25.17±2.69)分],差异有统计学意义(P<0.05)。观察组术后1 d IL-6、TNF-α水平低于对照组[(67.59±15.47)ng/L比(86.75±17.88)ng/L、(18.75±4.23)ng/L比(22.81±4.30)ng/L],IL-10水平高于对照组[(39.78±8.31)ng/L比(34.76±7.54)ng/L],差异有统计学意义(P<0.05)。两组术后不良事件总发生率比较差异无统计学意义(P>0.05)。结论CSEA可有效缓解老年髋部骨折手术患者术后疼痛,改善患者短期认知功能,减轻炎性反应,且安全性好。
Objective To investigate the effects of combined spinal-epidural anesthesia(CSEA)on postoperative pain and short-term cognitive function in elderly patients undergoing hip fracture surgery.Methods A total of 60 elderly patients undergoing hip fracture surgery in Dongchangfu District of Liaocheng People′s Hospital from October 2018 to September 2020 were selected as subjects and they were divided into the control group and the observation group by performed different anaesthesias methods,with 30 patients in each group.The control group underwent total intravenous anesthesia(TIVA),and the observation group underwent CSEA.The scores of visual analogue scale(VAS)at different points and the analgesic recovery rate within 48 h of the two groups were compared,and mini mental state evaluation(MMSE)scores of two groups at different points were evaluated.The levels of serum interleukin(IL)-6,IL-10 and tumor necrosis factor-α(TNF-α)of the two groups before the surgery and on the 1 d after the surgery were compared,and adverse events after the surgery were observed.Results The analgesic recovery rate within 48 h in the observation group was lower than that in the control group:3.33%(1/30)vs.26.67%(8/30),the difference was statistically significant(χ^(2)=6.40,P<0.05).The VAS scores at 4,6,12,24,48 h after the surgery in the observation group were lower than those in the control group(P<0.05).The scores of MMSE at 1 and 3 d after the surgery in the observation group were higher than those in the control group:(25.38±2.86)scores vs.(22.17±2.72)scores,(26.89±3.04)scores vs.(25.17±2.69)scores,the differences were statistically significant(P<0.05).At 1 d after the surgery,the levels of IL-6,TNF-αin the observation group were lower than those in the control group:(67.59±15.47)ng/L vs.(86.75±17.88)ng/L,(18.75±4.23)ng/L vs.(22.81±4.30)ng/L;and the level of IL-10 was higher than that in the control group:(39.78±8.31)ng/L vs.(34.76±7.54)ng/L,the differences were statistically significant(P<0.05).There was no statistical difference in the total incidence of postoperative adverse events between the two groups(P>0.05).Conclusions CSEA can effectively relieve postoperative pain,improve short-term cognitive function,reduce inflammatory response in elderly patients with hip fracture surgery,and with great safety.
作者
闫玉栋
周帅
李振庆
Yan Yudong;Zhou Shuai;Li Zhenqing(Department of Anesthesiology,Dongchangfu District of Liaocheng People′s Hospital,Liaocheng 252000,China)
出处
《中国医师进修杂志》
2023年第4期361-364,共4页
Chinese Journal of Postgraduates of Medicine
关键词
髋骨折
麻醉
脊椎
麻醉
全身
老年人
认知
Hip fractures
Anesthesia,spinal
Anesthesia,general
Aged
Cognition
