地氟醚对老年人行全髋关节置换术后早期认知功能的影响

目的 探讨地氟醚静吸复合全麻对比腰硬联合麻醉对老年患者行全髋关节置换术后早期认知功能的影响。 方法 选取行全髋关节置换术的老年患者(年龄>65岁)66例,采取计算机随机序列法将患者分为地氟醚组(D组)和腰硬联合麻醉组(C组)。围术期使用简易智能状态量表(MMSE)评估患者术前1 d及术后1,3,7 d的认知功能; 观察患者术后谵妄的发生率和麻醉满意度。 结果 术后1 d,C组和D组的MMSE评分均较术前明显下降(P<0.05),且D组低于C组(P<0.05)。术后3 d,D组的MMSE评分相较术前仍有下降(P<0.05),但较术后1 d升高(P<0.05); C组的MMSE评分与术前比较,差别有统计学意义(P<0.05),比术后1 d升高(P<0.05),但与D组比较差别无统计学意义(P>0.05)。术后7 d,两组的MMSE评分基本恢复至术前水平,且差别无统计学意义(P>0.05)。D组患者的麻醉满意度明显高于C组(P <0.01)。 结论 老年人行全髋关节置换术,使用地氟醚静吸复合全麻或腰硬联合麻醉,对患者术后认知功能障碍的影响无明显差异。

Effects of Desflurane on Early Cognitive Function afterTotal Hip Replacement in the Elderly Patients

Objective To compare the effects of desflurane combined anesthesia with combined spinal epidural anesthesia(CSEA)on early postoperative cognitive function in elderly patients undergoing total hip replacement. Methods 66 patients(aged over 65)who underwent the total hip replacement from June 2016 to July 2017 were selected. By computer random sequence method, the patients were randomly divided into desflurane group(group D)and CSEA group(group C). This study adopted MMSE(mini-mental state examination MMSE)to assess patients'' cognitive functions during the perioperativeperiod-1 d before surgery, 1 d, 3 d and 7 d after surgery. We also observed the prevalence of postoperative delirium and patient satisfaction with anesthesia. Results The collected data were processed by the method of repeated variance analysis. The results revealed that after operation, the scores of 1 d MMSE in group D and group C were significantly lower than they were before operation(P<0.05), while the score in group D was lower than that in group C(P<0.05). 3 d after the operation, the MMSE scores of group D were still lower than the preoperative level(P<0.05), but were higher than the data of 1 d(P<0.05). However, the scores of these two groups in this period showed no statistical difference. According to the data of 7 d after operation, the scores of two groups basically returned to the preoperative levels, and there was no statistical difference in the incidence of delirium between the two groups(P>0.05). The satisfaction of patients in group D was significantly higher than that in group C(P<0.01). Conclusion There is no significant difference in effects between desflurane anesthesia and CSEA on early postoperative cognitive function in elderly patients undergoing total hip replacement surgery.