不同麻醉方法对老年患者人工髋关节置换手术后认知功能的影响 |
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引用本文: | 王玺,余湘元,朱建华,孙皆,蔡洪勤. 不同麻醉方法对老年患者人工髋关节置换手术后认知功能的影响[J]. 湖南医学, 2014, 0(1): 115-117 |
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作者姓名: | 王玺 余湘元 朱建华 孙皆 蔡洪勤 |
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作者单位: | 江苏省昆山市第二人民医院麻醉科,江苏 昆山215300 |
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摘 要: | [目的]比较不同麻醉方式对于老年患者人工髋关节置换术后认知功能障碍(POCD )发生的影响。[方法]选拟择期行髋关节置换术的老年患者90例,性别不限,年龄65~90岁,体质量44~78 kg ,ASA分级Ⅰ~Ⅲ级。随机将其均分为三组各30例:静吸复合全麻组(GA组),腰硬联合麻醉组(CSEA组),神经阻滞麻醉组(NB组)。GA组静脉注射咪达唑仑0.03 mg/kg,利多卡因0.5mg/kg,芬太尼3μg/kg,丙泊酚1.5~2mg/kg,维库溴铵0.1mg/kg麻醉诱导,术中吸入七氟烷0.8~1.0 M AC ,根据需要间断给予芬太尼和维库溴铵;CSEA组L2~3穿刺,蛛网膜下腔给予0.5%布比卡因8~10 mg后置入硬膜外导管,麻醉平面上界调节在患侧T8以下,术中根据手术需要硬膜外追加0.5%罗哌卡因3~5 mL ;NB组在神经刺激仪定位下行患侧腰丛+坐骨神经阻滞。分别于手术前24h,手术后6h,24h,3d,7d采用简易认知状态检查(MMSE)量表进行认知功能评分,并比较各组差异。[结果]与术前比较,GA组在术后6 h ,24 h MMSE评分明显降低( P<0.05),CSEA组与NB组在术后6 h MMSE评分明显降低( P <0.05),与GA组比较,CSEA组与NB组在术后6 h ,24 h MMSE评分明显高于GA组( P <0.05)。术后6 h ,24 h时CSEA组与NB组POCD发生率明显低于GA组( P <0.05)。[结论]老年患者在人工髋关节置换术全麻比腰硬联合麻醉、下肢神经阻滞麻醉在术后6h,24h的 POCD 发生率更高,各种麻醉方式在手术后3d,7d的POCD发生率无明显差别。
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关 键 词: | 关节成形术 ,置换 ,髋 认知 麻醉 |
Effect of Different Anesthesia Methods on Cognitive Function of Elderly Patients After Artificial Hip Replace-ment |
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Affiliation: | WANG Xi, YU Xiang-yuan, ZHU Jian-hua ,et al ( Department of Anesthesiology, the Second People's Hospital of Kunshan City, Jiangsu 215300, China ) |
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Abstract: | [Objective] To compare the effect of different anesthesia methods on postoperative cognitive dysfunction (POCD) in elderly patients after artificial hip replacement .[Methods] A total of 90 ASA Ⅰ ~ Ⅲ patients(aged 65~90 years old and weighted 44~78kg) scheduled for elective HR surgery were chosen and randomly divided into venous inhalation com-bined general anesthesia group(group GA) ,combined spinal-epidural anesthesia group(group CSEA) and nerve blocking anes-thesia group(group NB) .In GA group ,patients were injected with intravenous midazolam 0 .03mg/kg ,fentanyl 3 μg/kg , propofol 1 .5~2mg/kg and vecuronium bromide 0 .1mg/kg for anesthesia induction ,and then inhaled with sevoflurane 0 .8~1 . 0 M AC during the operation ,and intermittently given fentanyl and vecuronium bromide for the anesthesia demand .In CSEA group ,patients underwent L2~3 puncture ,and were given intrathecal bupivacaine(0 .5% ) 8~10mg ,and then placed with epi-dural catheter ,and the upper bound of anesthesia level was regulated under Ts of the diseased side ,and epidural ropivacaine(0 . 5% ) 3~5mL was additionally given for anesthesia demand .In NB group ,patients received ipsilateral lumbar plexus-sciatic nerve block by using nerve stimulator .Mini-mental state exminination(MMSE) scale at 24h before operation and 6h ,24h ,3d and 7d after operation was used to assess the cognitive function .The difference among groups was compared .[Results] Com-pared with before operation ,MMSE scores in group GA at 6h and 24h after operation decreased obviously (P〈 0 .05) ,and MMSE scores in group CSEA and group NB at 6h after operation decreased obviously( P〈0 .05) .Compared with group GA , MMSE scores in group CSEA and group NB group at 6h and 24h after operation were obviously higher than those in group GA ( P 〈0 .05) .The incidence of POCD in group CSEA group and group NB at 6h and 24h after operation was obviously lower than that in group GA ( P 〈0 .05) .[Conclusion] The incidence of POCD in elderly patients undergoing artificial hip replace-ment at 6h and 24h after operation under general anesthesia is higher than that under combined spinal-epidural anesthesia and lower limb nerve blocking anesthesia .There is obvious difference in the incidence of POCD at 3d and 7d after operation among different ways of anesthesia . |
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Keywords: | Arthroplasty,Replacement,Hip Cognition Anesthesia |
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