全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的临床影响分析

Analysis of the clinical effects of general anesthesia and epidural anesthesia on postoperative short-term cognitive function in elderly orthopedic patients

目的分析全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的临床影响。方法选取本院2016年7月~2017年8月收治的老年骨科手术患者120例进行分组研究,按照随机数字表法分为对照组(n=60)和试验组(n=60),对照组予以全身麻醉,试验组在对照组基础上予以硬膜外麻醉,对两组术后短期认知功能、麻醉药用量、苏醒时间、语言恢复时间。结果麻醉前试验组MMSE评分(29.14±0.29)分与对照组(29.22±0.38)分比较差异无统计学意义;试验组麻醉后6 h、麻醉后12 h、麻醉后24 h MMES评分(24.36±1.31)分、(25.15±1.24)分、(27.22±2.34)分均高于对照组(22.03±1.86)分、(23.22±1.51)分、(26.36±1.24)分,组间差异具有统计学意义(P<0.05);两组麻醉药用量、苏醒时间、语言恢复时间比较,试验组(202.24±7.11)ml、(3.75±2.31)min、(6.21±3.11)min均少于对照组(227.30±9.88)ml、(11.62±3.42)min、(14.54±5.02)min(P<0.05)。结论相比于全身麻醉,全麻联合硬膜外麻醉可显著减少对老年骨科术后短期认知影响,缩短术后苏醒时间,值得在临床中优先选择和推广应用。

Objective To analyze the clinical effects of general anesthesia and epidural anesthesia on postoperative short-term cognitive function in elderly orthopedic patients. Methods A total of 120 elderly patients undergoing orthopaedic surgery in our hospital from July 2016 to August2017 were selected for group study. According to the random number table method, they were divided into control group（n=60） and experimental group（n=60）. The group was given general anesthesia. The experimental group was given epidural anesthesia on the basis of the control group. The two groups had short-term cognitive function, anesthetic dosage, recovery time, and language recovery time. Results There was no significant difference in the MMSE score（29.14±0.29）points between the pre-anesthesia group and the control group（29.22±0.38）points; the MMES score（24.36±1.31）points in the experimental group 6 h after anesthesia, 12 h after anesthesia, and 24 h after anesthesia（25.15±1.24）points and（27.22±2.34）points were higher than the control group（22.03±1.86）points,（23.22±1.51）points, and（26.36±1.24）points, with statistical significance between the groups（P〈0.05）. Two groups of anesthetic dosage, recovery time, language recovery time, test group（202.24±7.11）ml,（3.75±2.31）min,（6.21 ± 3.11）min were less than the control group（227.30 ± 9.88）ml（11.62 ± 3.42）min,（14.54 ± 5.02）min（P〈0.05）. Conclusion Compared with general anesthesia,general anesthesia combined with epidural anesthesia can significantly reduce the short-term cognitive effects on elderly orthopedic patients and shorten the time for resuscitation. It is worthwhile to select and popularize them in clinical practice.