【摘要】：目的 :探討全身麻醉和硬膜外麻醉對(duì)老年骨科患者凝血功能及術(shù)后認(rèn)知功能的影響。方法 :選取2015年2月至2016年2月擬在我院進(jìn)行全膝關(guān)節(jié)置換術(shù)的98例患者,按照麻醉方式的不同分為兩組:A組(硬膜外麻醉組,50例),B組(全身麻醉組,48例)。分別于麻醉前(T1)、麻醉后6h(T2)、術(shù)后24h(T3)抽取兩組患者的靜脈血5m L,檢測(cè)患者血清中血小板含量、纖維蛋白原濃度(FIB)、凝血原酶時(shí)間(PT)、部分激活凝血活酶時(shí)間(APTT)、D-二聚體水平,并分別于麻醉前(T1)、麻醉后6h(T2)、術(shù)后24h(T3)、麻醉后3d(T4)、麻醉后5d(T5)時(shí)間點(diǎn)采用簡(jiǎn)易精神狀態(tài)評(píng)分量表(MMSE)評(píng)估患者的認(rèn)知功能。結(jié)果 :兩組患者一般情況比較差異無(wú)統(tǒng)計(jì)學(xué)意義,具有可比性;兩組患者T1時(shí)點(diǎn)PT、APTT、FIB、D-二聚體、血小板含量相比差異無(wú)統(tǒng)計(jì)學(xué)意義,T2~T3時(shí)點(diǎn),兩組患者PT均高于術(shù)前水平但組間相比無(wú)統(tǒng)計(jì)學(xué)意義,A組患者APTT明顯高于B組而FIB、D-二聚體、血小板含量明顯低于B組,差異有統(tǒng)計(jì)學(xué)意義;兩組患者T1、T5時(shí)間點(diǎn)MMSE評(píng)分相比差異無(wú)統(tǒng)計(jì)學(xué)意義,T2~T4時(shí)間點(diǎn)A組MMSE評(píng)分顯著高于B組,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:與全麻相比,對(duì)老年骨科患者實(shí)施硬膜外麻醉不僅能夠顯著改善凝血功能而且對(duì)患者術(shù)后認(rèn)知功能的影響更小,更有助于患者術(shù)后的恢復(fù)。
[Abstract]:Objective: to investigate the effects of general anesthesia and epidural anesthesia on coagulation function and postoperative cognitive function in elderly orthopedic patients. Methods: from February 2015 to February 2016, 98 patients with total knee arthroplasty were divided into two groups: group A (epidural anesthesia group, n = 50) and group), B (general anesthesia group, n = 48). Before anesthesia (T1), 6 hours after anesthesia (T2) and 24 hours after anesthesia (T3), the venous blood samples of the two groups were taken to detect platelet content, fibrinogen concentration, (FIB), thromboplastin time (PT),. The time of partial activation of thromboplastin (APTT), D-dimer) was measured before anesthesia (T1), at 6h (T2) after anesthesia, at 24h (T3) after anesthesia, and at 3D (T4) after anesthesia. The cognitive function of the patients was assessed by mini mental state scale (MMSE) at 5 days after anesthesia (T 5). Results: there was no significant difference in the general situation between the two groups, and there was comparability between the two groups. There was no significant difference in PT,APTT,FIB,D- dimer and platelet content between the two groups at T1 point. At T2~T3 time point, PT in both groups was higher than that before operation, but there was no significant difference between the two groups. APTT in group A was significantly higher than that in group B while FIB, was significantly higher in group A than in group B. The levels of D-dimer and platelet in group B were significantly lower than those in group B (P < 0.05). There was no significant difference in MMSE scores between the two groups at time point T 1 and T 5, but MMSE score in group A was significantly higher than that in group B at the time point of T2~T4 (P < 0.05). Conclusion: compared with general anesthesia, epidural anesthesia in elderly orthopedic patients can not only significantly improve coagulation function, but also has less effect on postoperative cognitive function, and is more helpful to postoperative recovery.
【作者單位】： 北京市海淀醫(yī)院麻醉科;
【分類號(hào)】：R614

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