全身麻醉和椎管内麻醉对老年骨科手术患者术后精神状态及认知功能的影响

目的:观察全身麻醉和椎管内麻醉对老年骨科手术患者术后精神状态及认知功能的影响,为临床进行老年患者骨科手术选择麻醉术式提供参考。方法:选取2016年1月-2017年12月间我院收治的102例接受骨科手术的老年患者,随机分为2组。对照组50例,采用全身麻醉;观察组52例,采用椎管内麻醉。记录并比较患者手术时间、麻醉药用量、睁眼时间、语言陈述时间等手术相关指标;依照精神状态简易量表(MMSE)评估患者术前、术后各节点的认知功能;比较患者出现认知功能障碍等术后不良反应发生率。结果:观察组患者手术时间、睁眼时间均低于对照组,但差异不显著(P>0.05);观察组患者术中麻醉药用量、术后清醒时语言陈述时间显著低于对照组(P<0.05).术后1小时内2组MMSE均显著降低(P<0.05),术后1-8小时,对照组评分明显低于观察组(P<0.05);术后16小时时,观察组MMSE恢复至与术前水平,对照组MMSE在术后24小时恢复至术前水平(P>0.05)。观察组患者术后低血氧症、认知功能障碍发生率显著低于对照组(P<0.05)o结论:椎管内麻醉能以较少的麻醉药物剂量达到缩短术后清醒时间的效果,且对老年患者术后精神、认知功能影响较低,并且降低术后不良反应发生的风险,有利于促进患者康复,值得在老年骨科患者手术中推广。

Comparison of General Anesthesia and Intraspinal Anesthesia on Postoperative Mental Status and Cognitive Function in Senile Orthopedics Surgery Patients

Objective:To compare the clinical efficacy of general anesthesia and intraspinal anesthesia on postoperative mental status and cognitive function in senile patients undergoing orthopedics surgery.Methods:102 senile patients(all above age 60)operated with orthopedics surgery in our hospital from January 2016 to December 2017 were enrolled.Patients were divided into two groups:control group(50 patients)was treated with general anesthesia,while the observation group(52 patients)was treated with intraspinal anesthesia before surgery,respectively.The indicators of surgery were recorded and analyzed between groups.MMSE scale and incidence of cognitive dysfunction were used to evaluate the mental restoration and cognitive recovery after surgery.Results:The operation time and eye opening time of observation group was less than control(P>0.05).The amount of anesthetic and language recovery time were significantly lower in observation group(P<0.05).Besides,the MMSE scale showed significant higher score in observation group in lh,4h,8h after sur-gery(P<0.05).The incidence of hypoxic and postoperative cognitive dysfunction in observation group was significantly lower(P<0.05).Conclusion:Intraspinal anesthesia has an advantage in accelerating postoperative sobriety with less amount of anesthetic.It also de-creases the risk of postoperative cognitive dysfunction in senile patients,which provides a promising way in future clinical anesthesia appli-cation for elderly patients.