局部麻醉与全身麻醉对老年髋部骨折术后谵妄的影响

Effects of Local Anesthesia and General Anesthesia on Postoperative Delirium in Elderly Patients with Hip Fracture

目的对比分析局部麻醉与全身麻醉在老年髋部骨折术中运用效果,旨在为今后更有效防治老年髋部骨折术后谵妄发生提供麻醉方式及处理措施指导。方法前瞻性选取我院骨科在2015年1月至2017年1月收治的100例单侧急性(≤2 w)髋部骨折并需手术治疗的老年患者作为研究对象,采用信封法随机分为局部麻醉组和全身麻醉组,每组各50例,通过不同麻醉方式顺利实施手术,并运用谵妄DRS-R-98量表记录患者术后7 d内发生谵妄情况,同时对谵妄类型、严重程度、持续时间、术后疼痛评分、相关并发症与转归、住院时间、住院总费用和麻醉费用、住院期和术后30 d死亡率等进行统计,并随访存活患者出院6个月、1年内的术后情况。结果局部麻醉组患者发生谵妄于术后、出院后均明显低于全身麻醉组术后、出院后,经组间成组χ2检验其P值均<0.05;同时两组患者发生谵妄的分型、严重程度、平均持续时间比较,其差异无统计学意义(P>0.05);局部麻醉组术后VAS评分与全身麻醉组比较其差异无统计学意义(P>0.05);局部麻醉组发生肺部感染、心肌梗死、肾衰、消化道出血等并发症明显低于全身麻醉组(P<0.01),其死亡率也低于全身麻醉组(P<0.05);局部麻醉组住院期总费用及麻醉费用明显低于全身麻醉组(P<0.01)。结论采取局部麻醉对于减少老年髋部骨折患者术后谵妄等并发症方面明显优于全身麻醉,降低患者术后死亡率,同时减少住院费用,减轻患者及其家属经济负担,值得临床推广运用。

Objective To compare the effects of local anesthesia and general anesthesia in the treatment of hip fracture in elderly patients in order to provide guidance for the prevention and treatment of postoperative delirium in elderly patients with hip fracture. Methods 100 elderly patients with unilateral acute （ 〈~ 2 weeks） hip fractures who underwent surgical treatment in our hospital from January 2015 to January 2017 were prospectively selected as the research object. The patients were randomly divided by envelop meth- od into two groups： local anesthesia group and general anesthesia group, with 50 cases in each group. The operation was carried out smoothly through different anesthetic methods, and patients＇ delirium within 7 days after operation was recorded by the DRS-R-98 scale. Meanwhile, the delirium type, severity, duration, postoperative pain score, complications and outcome, hospitalization time, hospitalization costs and the cost of anesthesia, duration of hospitalization and the mortality of postoperative 30 clays were statis- tically analyzed, and the physical conditions of survival patients after six months or one year after discharge were followed up. Results The incidence of delirium after operation and discharge in local anesthesia group was much lower than that in the general anesthesia group, with P〈0. 05 by X2 test among groups. Meanwhile there were no significant differences in delirium types, severity and the aver- age duration between two groups （ P〉0. 05 ）. There was no significant difference in postoperative VAS score between local anesthesia group and general anesthesia group （P〉 0. 05 ）. The complications of pulmonary infection, myocardial infarction, renal failure and gastrointestinal hemorrhage in local anesthesia group were significantly lower than those in general anesthesia group （ P 〈0. 01 ） and its mortality rate was also lower than that in the general anesthesia group （P〈0. 05）. The total cost and anesthesia cost of the local anes- thesia group were significantly lower than those of the general anesthesia group （ P〈0.01 ）. Conclusion Local anesthesia is superiorto general anesthesia in reducing the complications of postoperative delirium in elderly patients with hip fractures, reducing the postop- erative mortality, the cost of hospitalization and the economic burden of patients and their families. Thus, it is worthy of clinical appli- cation.