星状神经节阻滞对老年骨科手术患者术后早期认知功能的影响

Effect of stellate ganglion block on early postoperative cognitive function in elderly patients with orthopedic surgery

目的分析星状神经节阻滞（SGB）对老年骨科手术患者术后早期认知功能的影响。方法选取骨科手术治疗的老年患者115例进行研究，采用随机数字表法分为观察组55例，对照组60例。观察组SGB后行硬膜外麻醉，对照组只进行常规硬膜外麻醉。术前以及术后6h、术后3d和7d分别测定并比较患者简易精神状态检查量表（MMSE）评分，进行认知功能评定，比较两组手术前后MMSE评分及术后认知功能障碍（POCD）发生情况。结果观察组术前MMSE评分为（29．36±2．54）分，术后6h、术后3d和术后7d的评分分别为（22．69±3．01）分、（25．33±2．69）分、（28．32±3．04）分，手术前后MMSE评分差异有统计学意义（F=51．26，P〈0．05）。对照组术前和术后3个时间点的MMSE评分分别为（29．69±2．17）分、（20．24±3．59）分、（21．87±2．02）分和（27．66±3．07）分，差异有统计学意义（F=103．70，P〈0．05）。观察组与对照组比较，术前MMSE评分两组差异无统计学意义；术后6h和术后3d的MMSE评分观察组高于对照组（t=3．947、7．745，均P〈0．05）；术后7d两组MMSE评分差异无统计学意义。术后6hPOCD的发生率：观察组为3．64％，对照组为11．67％；术后3d POCD发生率：观察组1．82％，对照组3．33％；两组在术后6h和3d的POCD发生率差异无统计学意义。术后7d观察组未检出POCD，对照组发生率为3．33％。POCD总发生率：观察组为5．45％，对照组为18．33％，观察组发生率更低（Х^2=4．452，P〈0．05）。结论SGB可改善老年骨科术后患者的早期认知功能水平，值得临床推荐。

Objective To investigate the effect of stellate ganglion block （SGB） on early postoperative cognitive function in elderly patients undergoing orthopedic surgery. Methods 115 elderly patients with orthopedic surgery were selected as study objects, and they were randomly divided into observation group（ 55 cases） and control group（60 cases） according to the digital table. The observation group received epidural anesthesia after SGB,while the control group only received routine epidural anesthesia. Preoperation and postoperative 6h,3d and 7d, the mini mental state examination （MMSE） scores were measured and compared, the cognitive function was assessed. The MMSE score and postoperative cognitive dysfunction （POCD） occurrence before and after surgery in the two groups were compared. Results In the observation group, the preoperative MMSE score was （ 29.36 ± 2.54 ） points, the MMSE scores of 6h,3d and 7d after operation were （22.69 ± 3.01 ）points, （25.33 ± 2.69）points, （28.32 ± 3.04） points, respectively. The difference between preoperation and postoperation was statistically significant （ F = 51.26,P 〈 0. 05）. In the control group, the MMSE scores of before surgery and 6h, 3d, 7d after surgery were （29. 69 ± 2.17 ） points, （20.24 ± 3.59） points, （21.87 ± 2.02） points and （27.66 ± 3.07） points, respectively, the difference was statistically significant （F = 103.70 ,P 〈 0.05 ）. Before surgery,the MMSE score between the observation group and control group had no statistically significant difference. 6h and 3d after surgery, the MMSE scores of the observation group were higher than those of the control group（ t = 3. 947,7. 745, all P 〈 0.05 ） ;7d after operation, the MMSE score between the two groups had no statistically significant difference（ P 〉 0.05 ）. 6h after surgery, the incidence rate of POCD of the observation group was 3.64%, which of the control group was 11.67%. 3d after operation, the incidence rate of POCD was 1.82% in the observation group and 3.33% in the control group. There was no statistically significant difference in the incidence of POCD between the two groups at 6 and 3d after operation（ P 〉 0.05 ）. 7d after operation, POCD was not detected in the observation group, and the incidence rate of the control group was 3.33%. The total incidence rate of POCD was 5.45% in the observation group and 18.33% in the control group,and the incidence rate of the observation group was lower （ Х^2 = 4. 452, P 〈 0.05 ）. Conclusion SGB can improve the cognitive function of elderly patients after orthopedic surgery, and it is worthy of clinicaX recommendation.