罗哌卡因复合舒芬太尼硬膜外麻醉对老年髋关节置换术患者认知功能的影响

Effect of epidural anesthesia by ropivacaine in combination with sufentanil on the cognitive function of elderly patients undergoing hip arthroplasty

目的探讨罗哌卡因复合舒芬太尼硬膜外麻醉对老年髋关节置换术(hip arthroplasty,HA)患者认知功能的影响。方法300例老年HA患者分为硬膜组和全麻组各150例,均接受全麻,硬膜组另给予给予罗哌卡因复合舒芬太尼硬膜外麻醉,观察患者手术过程中的血流动力学、麻醉效果、麻醉药物用量、苏醒及认知功能情况。结果硬膜组麻醉后10min(T1)、术中(T2)、术毕(T3)的平均动脉压(MAP)、心率(HR)明显低于全麻组,麻醉优良率明显高于全麻组,差异均有统计学意义(P<0.05);硬膜组麻醉药物用量、呼之睁眼时间、苏醒时间及认功能障碍(dysfunction,DF)率明显低于全麻组,硬膜组术后12、24h简易精神状况检查量表(MMSE)评分明显高于全麻组,差异有统计学意义(P<0.05)。结论罗哌卡因复合舒芬太尼硬膜外麻醉可有效改善老年HA患者血流动力学、麻醉效果,有利于减少麻醉药物用量,且可有效减少患者苏醒及认知功能的不良影响。

Objective To evaluate the effect of epidural anesthesia by means of ropivacaine combined with sufentanil on the cognitive function of elderly patients undergoing hip arthroplasty (HA). Methods Firstly, 300 patients undergoing HA were divided into two groups, namely, epidural anesthesia group ( n =150) and general anesthesia group ( n =150). Both groups were treated with general anesthesia where the epidural anesthesia group was subjected to treatment with ropivacaine combined with sufentanil for epidural anesthesia in addition to the general anesthesia as given to the general anesthesia group. The hemodynamics, anesthesia effect, narcotic drugs dosage, awakening and cognitive function of the two groups as observed during surgery were compared. Results The mean arterial pressure (MAP) and heart rate (HR) of the epidural anesthesia group as observed at T 1 (10 min after anaesthesia), T 2 (in the process of surgery), and T 3 (after surgery) were lower than those in the general anesthesia group. The rate of excellent conduct of anesthesia in the epidural group was higher than that in the general anesthesia group. The differences were statistically significant ( P <0.05). The narcotic drugs dosage, opening eyes time, awakening time and the dysfunction (DF) rate in the epidural group were lower than those in the general anesthesia group. The scores achieved by the epidural anesthesia group 12 h and 24 h after surgery as computed by simple mental state examination scale (MMSE) were higher than those in the general anesthesia group. The difference was statistically significant ( P <0.05). Conclusions Ropivacaine combined with sufentanil epidural anesthesia can effectively improve the hemodynamics and anesthetic effect in elderly patients undergoing HA and thus favorably reduce narcotic drugs dosage and effectively reduce the adverse effects as to awakening and cognitive function of the patients.