全麻与腰硬联合麻醉对老年骨科手术患者术后认知功能及镇痛效果的影响

Effect of General Anesthesia and Combined Spinal and Epidural Anesthesia on Postoperative Cognitive Function and Analgesia in Elderly Patients Undergoing Orthopaedic Surgery

目的:研究全麻与腰硬联合麻醉对老年骨科手术患者术后认知功能及镇痛效果的影响。方法:选取2017年7月-2018年3月在本院就诊的老年骨科手术患者92例。按照麻醉方式不同将其分为全麻组与腰硬联合麻醉组,各46例。全麻组患者给予全麻,腰硬联合麻醉组患者实施腰硬联合麻醉。观察两组手术前后的认知功能评分,以及术后的疼痛程度评分。结果:手术前及术后1周,两组认知功能评分比较,差异均无统计学意义(P>0.05);手术清醒后即刻及术后3 d,腰硬联合麻醉组认知功能评分均高于全麻组,比较差异均有统计学意义(P<0.05);术后2周,两组疼痛程度评分比较,差异无统计学意义(P>0.05);术后3周及术后1、3个月,腰硬联合麻醉组疼痛程度评分均低于全麻组,比较差异均有统计学意义(P<0.05)。结论:老年骨科手术患者采用腰硬联合麻醉疗效显著,不仅术后认知功能良好,且镇痛效果良好,可减轻患者术后疼痛程度,值得临床推广使用。

ObjectiveTo study the effects of general anesthesia and combined spinal and epidural anesthesia on postoperative cognitive function and analgesia in elderly patients undergoing orthopaedic surgery.Method：A total of 92 elderly patients undergoing orthopaedic surgery in our hospital from July 2017 to March 2018 were selected.According to different anesthesia methods,they were divided into general anesthesia group and combined spinal and epidural anesthesia group,46 cases in each group.General anesthesia group received general anesthesia,and combined spinal and epidural anesthesia group received combined spinal and epidural anesthesia.The cognitive function scores before and after operation,and postoperative pain scores after operation of two groups were observed.Result：Before operation and after operation 1 week,the cognitive function scores of two groups were compared,the differences were not statistically significant（P〉0.05）.After operation immediately and after operation 3 days,the cognitive function scores of combined spinal and epidural anesthesia group were higher than those of general anesthesia group,the differences were statistically significant（P〈0.05）.After operation 2 weeks,the pain scores of two groups were compared,the difference was not statistically significant（P〉0.05）.After operation 3 weeks,1 month and 3 months,the pain scores of combined spinal and epidural anesthesia group were lower than those of general anesthesia group,the differences were statistically significant（P〈0.05）. Conclusion：The efficacy of combined spinal and epidural anesthesia in elderly patients undergoing orthopaedic surgery is remarkable,not only has a good postoperative cognitive function,but also has a good analgesic effect,can reduce postoperative pain and is worthy of clinical application.