腰硬联合麻醉对老年股骨颈骨折患者围术期应激反应与术后认知功能的影响

目的探讨腰硬联合麻醉对老年股骨颈骨折患者围术期应激反应与术后认知功能的影响。方法选取2018年10月至2019年12月本院收治的老年股骨颈骨折患者70例作为研究对象,按随机信封法分为对照组与观察组,各35例。对照组给予气管插管全麻,观察组给予腰硬联合麻醉。于不同时点(麻醉前、麻醉后即刻、手术开始、麻醉结束)监测并记录心率(HR)和平均动脉压(MAP),评估麻醉效果,于术后6、24、48 h采用简易精神状态评价量表(MMSE)评估术后认知功能。结果麻醉后即刻(T1)两组HR、MAP均出现下降,其中观察组降幅较小,两组HR、MAP比较差异有统计学意义(P<0.05);手术开始时(T2)观察组HR、MAP与T1时比较差异无统计学意义,对照组较T1时明显升高(P<0.05);手术结束时(T3)两组HR、MAP均有一定升高,但观察组幅度较小,与T0时比较差异无统计学意义,且低于同时点对照组(P<0.05),对照组升幅较大,与T0时差异有统计学意义(P<0.05)。观察组麻醉优良率高于对照组,但组间比较差异无统计学意义。术前,两组MMSE评分比较差异无统计学意义,术后6、24、48 h,两组MMSE评分均明显低于术前(P<0.05),观察组MMSE评分均明显高于对照组(P<0.05)。结论腰硬联合麻醉能减轻老年股骨颈骨折患者围术期应激反应,提高麻醉效果,且对术后认知功能的影响较气管插管全麻更小。

Effect of combined spinal-epidural anesthesia on perioperative stress response and postoperativecognitive function in elderly patients with femoral neck fracture

Objective To explore the effect of combined spinal-epidural anesthesia on perioperative stress response and postoperative cognitive function in elderly patients with femoral neck fracture.Methods 70 elderly patients with femoral neck fractures admitted to our hospital from October 2018 to December 2019 were selected as the reseach subjects and they were divided into the control group and the observation group according to the random envelope method,with 35 cases in each group.The control group was given general anesthesia with tracheal intubation,and the observation group was given combined spinal-epidural anesthesia.Monitor and record heart rate(HR)and mean arterial pressure(MAP)at different time points(before anesthesia,immediately after anesthesia,start of surgery,end of anesthesia)to evaluate the anesthesia effect,and adopt simple mental state at 6 h,24 h,and 48 h after surgery the Evaluation Scale(MMSE)assesses postoperative cognitive function.Results After anesthesia(T1),HR and MAP of two groups decreased immediately,the observation group had smaller decrease,and there was statistically significant difference in HR and MAP between the two groups(P<0.05);There was no statistically significant difference in HR,MAP and T1 in the observation group at the beginning of the operation(T2).The control group was significantly higher than that at T1(P<0.05);at the end of the operation(T3),both HR and MAP increased to certain extent,but the observation group had smaller amplitude,which was similar to T0.There was no statistically significant difference in time comparison, and it was lower than that of the control group at the same point (P<0.05). The control group has a larger increase, which is statisticallydifferent from T0 (P<0.05). The excellent and good rate of anesthesia in the observation group was higher than that in the control group, butthere was no significant difference between the groups. There was no significant difference in MMSE scores between the two groups before surgery.The MMSE scores of the two groups at 6 h, 24 h, and 48 h after surgery were significantly lower than those before surgery (P<0.05), and the MMSEscores of the observation group were significantly higher than those of the control group (P<0.05). Conclusion Combined spinal-epidural anesthesiacan reduce the perioperative stress response in elderly patients with femoral neck fractures, improve the effect of anesthesia, and have a smaller impacton postoperative cognitive function than endotracheal intubation general anesthesia.