全麻与腰硬联合麻醉对老年骨科手术患者认知功能及镇痛效果的影响

目的 探讨采用全麻与腰硬联合麻醉对老年骨科患者认知功能及镇痛效果的影响。方法 回顾性分析我院2017年7月~2018年12月骨科手术的60例老年患者，根据术中麻醉方式分为对照组（n=28）及观察组（n=32）。对照组于骨科手术中选用全麻方式，观察组术中选用腰硬联合麻醉方式，比较两组认知功能（MMSE评分）、镇痛效果（VAS评分）及血流动力学指标。结果 对照组T1、T2时间点MMSE评分较观察组低，差异有统计学意义（P＜0.05）；两组术后2、6、12 h VAS评分逐渐降低，差异有统计学意义（P＜0.05）；但两组不同时间点VAS评分对比，差异无统计学意义（P＞0.05）；观察组手术前后血压、心率指标对比，差异无统计学意义（P＞0.05）；与术前相比，对照组术后血压降低，心率升高，差异有统计学意义（P＜0.05）。结论 全麻与腰硬联合麻醉对老年骨科手术患者均具有良好镇痛效果，但腰硬联合麻醉对患者认知功能及血流动力学指标影响更小，且有利于患者术后恢复。

Effect of General Anesthesia Combined with Spinal Epidural Anesthesia on Cognitive Function and Analgesic Effect in Elderly Patients Undergoing Orthopedic Surgery

Objective To investigate the effect of combined anesthesia and spinal epidural anesthesia on cognitive function and analgesic effect in elderly patients undergoing orthopedic surgery.Methods A retrospective analysis of 60 elderly patients in our hospital from July 2017 to December 2018 was divided into control group(n=28)and observation group(n=32)according to the intraoperative anesthesia method.The control group used general anesthesia in orthopedic surgery,and the observation group used spinal and epidural anesthesia,and compared the cognitive function (MMSE score),analgesic effect(VAS score),and hemodynamic indexes of the two groups.Results The MMSE score of the control group at T1 and T2 time points was lower than that of the observation group,the difference was statistically significant(P＜0.05);the VAS scores of the two groups were gradually decreased at 2,6,and 12 h after surgery,the difference was statistically significant(P＜0.05);However,there was no significant difference in VAS scores between the two groups at different time points(P＜0.05);There was no significant difference in blood pressure and heart rate indicators in the observation group before and after surgery (P＞0.05);Compared with the preoperative group,the blood pressure of the control group decreased and the heart rate increased,the difference was statistically significant(P＜0.05).Conclusion The general anesthesia and the combination of lumbar and epidural anesthesia have good analgesic effect on the elderly patients with orthopedic operation,but the effect of the combination of the lumbar and epidural anesthesia on the cognitive function and the hemodynamic indexes of the patients is less,which is favorable for postoperative recovery.