本文關(guān)鍵詞： 麻醉 全身 麻醉和鎮(zhèn)痛 股骨骨折 外科手術(shù) 認(rèn)知障礙 老年人　出處：《臨床誤診誤治》2016年10期 　論文類型：期刊論文

【摘要】：目的比較不同麻醉及術(shù)后鎮(zhèn)痛方式對(duì)于老年股骨骨折患者術(shù)后早期認(rèn)知功能的影響。方法選取擇期行手術(shù)治療的老年股骨頸或股骨粗隆骨折患者75例,根據(jù)麻醉及術(shù)后鎮(zhèn)痛方式的不同均分為靜脈全身麻醉組(GA組)、腰硬聯(lián)合麻醉組(CSEA組)和神經(jīng)阻滯組(NB組)。GA組給予靜脈全身麻醉及術(shù)后靜脈鎮(zhèn)痛泵鎮(zhèn)痛,CSEA組給予腰硬聯(lián)合麻醉及術(shù)后硬膜外自控鎮(zhèn)痛,NB組給予腰叢神經(jīng)、坐骨神經(jīng)阻滯及術(shù)后腰叢神經(jīng)自控鎮(zhèn)痛。觀察并記錄各組術(shù)后6、12、24、48 h疼痛視覺(jué)模擬評(píng)分(visual analogue scale,VAS),術(shù)前和術(shù)后1、3、7 d簡(jiǎn)易智力狀態(tài)檢查量表(MMSE)評(píng)分,以及術(shù)后認(rèn)知功能障礙(postoperative cognitive dysfunction,POCD)發(fā)生情況。結(jié)果 CSEA組、NB組術(shù)后6、12、24、48 h VAS評(píng)分均低于GA組(P0.05或P0.01);術(shù)后1 d MMSE評(píng)分NB組CSEA組GA組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后3 d MMSE評(píng)分,NB組CSEA組和GA組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);3組術(shù)后1 d MMSE評(píng)分與麻醉前比較明顯降低(P0.05)。術(shù)后1、3 d NB組POCD發(fā)生率均低于其他兩組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05或P0.01);且術(shù)后1 d GA組POCD發(fā)生率高于CSEA組(P0.05);術(shù)后7 d 3組均無(wú)POCD發(fā)生。結(jié)論老年股骨手術(shù)患者全身麻醉較其他麻醉方式有更高的早期POCD發(fā)生率,神經(jīng)阻滯可能是老年股骨手術(shù)更為安全、有效的麻醉和術(shù)后鎮(zhèn)痛方式。
[Abstract]:Objective to compare the effect of different anaesthesia and postoperative analgesia on the early postoperative cognitive function in elderly patients with femoral fracture. Methods 75 elderly patients with femoral neck or femoral trochanteric fractures were selected for elective surgical treatment. According to the different anaesthesia and postoperative analgesia methods, they were divided into intravenous general anesthesia group (GA group), spinal epidural anesthesia group (CSEA group) and nerve block group (NB group). GA group was given intravenous general anesthesia and postoperative intravenous analgesia pump analgesia (CSEA group). Combined epidural anesthesia and postoperative patient-controlled epidural analgesia were given to lumbar plexus nerve in NB group. Sciatic nerve block and postoperative lumbar plexus analgesia were observed and recorded. Visual analogue scale scale and MMSE score were observed and recorded in each group after operation for 48 h, 1 day before and 3 days after operation, 3 days after operation, and 7 days after operation, the scores of visual analogue of pain and visual analogue scale were recorded. Results the VAS scores in CSEA group were significantly lower than those in GA group (P 0.05 or P 0.01), and MMSE scores in NB group were significantly lower than those in CSEA group at 1 day after operation. There were significant differences in the MMSE scores between NB group and CSEA group and GA group on the 3rd day after operation. The MMSE score on the 1st day after operation in the NB group and the GA group was significantly lower than that before anesthesia. The incidence of POCD in NB group was lower than that in the other two groups on the 1st day after operation, and the incidence rate of POCD in the NB group was lower than that in the other two groups on the 1st day after operation. The incidence of POCD in GA group was higher than that in CSEA group on the 1st day after operation, and no POCD occurred in 3 groups on the 7th day after operation. Conclusion the incidence of early POCD in elderly patients undergoing general anesthesia is higher than that in other anesthesia methods. Nerve block may be a more safe and effective anaesthesia and postoperative analgesia for senile femur surgery.
【作者單位】： 珠海市人民醫(yī)院麻醉科;
【分類號(hào)】：R614

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