全麻联合硬膜外麻醉对老年患者股骨头置换术后近期认知功能障碍的影响

EFFECT OF GENERAL COMBINED EPIDURAL ANESTHESIA ON RECENT POSTOPERATIVE COGNITIVE DYSFUNCTION IN PATIENTS WITH FEMORAL HEAD REPLACEMENT

目的探究全麻联合硬膜外麻醉对股骨头置换患者术后近期认知功能障碍的影响。方法选取2011年1月—2014年9月在该院接受治疗的68例股骨头置换患者,按照随机数字法分为观察组和对照组,观察组35例,采用全麻联合硬膜外麻醉;对照组33例,采用全身麻醉。比较二组患者术后近期认知功能状态。结果观察组患者在本次研究中的苏醒时间为(29.17±7.52)min,拔管时间为(29.55±7.70)min,应答时间为(30.23±8.21)min;对照组患者苏醒时间为(30.29±7.94)min,拔管时间为(32.61±8.05)min,应答时间为(32.89±8.76)min。观察组患者在本次研究中MMSE在术前30min的得分为(28.81±1.33)分,术后6h为(26.32±1.49)分,术后12h为(24.84±1.73)分,术后24h为(27.63±1.51)分;对照组患者在本次研究中MMSE在术前30min的得分为(29.32±1.45)分,术后6h为(25.17±1.51)分,术后12h为(23.99±1.57)分,术后24h为(26.22±1.35)分。术后6 h和术后12 h认知功能障碍发生率观察组分别为11.43%和8.57%,对照组分别为24.24%和15.15%,观察组均低于对照组。结论全麻联合硬膜外麻醉的方式较全身麻醉的方式可以减少对老年患者股骨头置换术后近期认知功能障碍的的影响,对老年患者更为安全和有效。

Objective To explore the general combined epidural anesthesia of recent postoperative cognitive dysfunction in patients with femoral head replacement.Methods Between January2011 and September 2014 in author’s hospital for treatment of 68 patients with femoral head replacement,divided into two groups according to random number method,the observation group and the control group.The observation group of 35 cases,received general combined epidural anesthesia,the control group 33 cases,received general anesthesia.Postoperative cognitive function in the recent between the two groups of patients was compared.Results After operation,come to oneself,tube drawing and response time in the experimental group of patients in the study of waking time was（29.17±7.52 min）,extubation time was（29.55±7.70 min）,response time was（30.23±8.21 min）;they were（30.29±7.94 min）,（32.61±8.05 min,（32.89±8.76 min）respectively.The experimental group of patients in the study of the MMSE in preoperative 30 min were（28.81±1.33）score,postoperative 6 h were（26.32±26.32）score,12 h after surgery for（24.84±1.73）score,24 h after surgery（27.63±1.51）score.Control group of patients in the study of the MMSE in preoperative scores for 30 min（29.32±1.45）score,postoperative 6 h was（25.17±1.51）score,postoperative 12 h was（23.99±1.57）score,24 h after surgery（26.22±1.35）score.6 h after surgery and postoperative 12 h incidence of cognitive dysfunction in observation group were 11.43% and 8.57%respectively,the control group were 24.24% and 15.15% respectively,the observation group was lower than the control group.Conclusion General anesthesia combined epidural anesthesia way a way can reduce the influence of recent cognitive dysfunction after femoral head replacement for elderly patients with general anesthesia,and it is more safe and effective for elderly patients.