全身麻醉与腰硬联合麻醉对老年下肢骨折术后认知功能及疼痛评分的影响比较

Influence Comparison of General Anesthesia and Combined Spinal Epidural Anesthesia on Postoperative Cognitive Function and Pain Score for Elderly Patients with Lower Limb Fracture

目的比较全身麻醉和腰硬联合麻醉对老年下肢骨折手术患者术后认知功能及疼痛的影响。方法选取2012年11月至2015年10月接受手术治疗的老年下肢骨折患者180例,按麻醉方法的不同分为治疗组与对照组,各90例。治疗组患者采用腰硬联合麻醉,对照组患者采用全身麻醉,对比两组患者术后认知功能障碍(POCD)发生率及疼痛视觉模拟(VAS)评分。结果治疗组患者POCD发生率为15.56%,明显低于对照组患者的33.33%(P<0.05);治疗组患者术后即刻及术后第3,7天简易智力状态检查量表(MMSE)评分明显高于对照组(P<0.05);治疗组患者术后第6,10,15天VAS评分显著低于对照组(P<0.05)。结论腰硬联合麻醉对老年下肢骨折手术患者的认知功能影响较小,患者术后疼痛更轻,恢复更快,值得临床推广。

Objective To investigate the influence comparison of general anesthesia and combined spinal epidural anesthesia（CSEA） on postoperative cognitive function and pain scores in elderly patients with lower limb fracture. Methods Totally 180 elderly patients with lower limb fractures admitted to the hospital from November 2012 to October 2015 were divided into the treatment group and the control group according to the different anesthesia methods,90 cases in each group. The treatment group was treated by CSEA,while the control group was treated by general anesthesia. The incidence of postoperative cognitive dysfunction（POCD） and the score of postopera- tive pain in the two groups were compared. Results The incidence of POCD in the treatment group was 15.56% ,which was signifi- cantly lower than that 33.33% in the control group（P 〈 0. 05）;the MMSE scores of the treatment group were significantly higher than those of the control group at the finish time,3 d,7 d after operation respectively（P 〈 0.05）;the visual analogue scale（VAS） scores of the treatment group were significantly higher than those of the control group at 6,10,15 d after operation（ P 〈 0. 05）. Conclusion The treatment of CSEA has less impact of cognitive function on elderly patients with lower limb fracture surgery, and the postoperative pain is fighter,the recovery is faster,it is worthy of clinical promotion.