腰麻-硬膜外麻醉对老年股骨远端骨折患者术后肺部感染及认知功能影响

Effect of spinal anesthesia and epidural anesthesia on postoperative pulmonary infection and cognitive function in elderly patients with distal femoral fracture

目的内固定术为治疗股骨远端骨折重要术式,治疗效果肯定,但存在一定创伤性,且老年患者对手术与麻醉耐受性差,手术、麻醉风险高。腰麻-硬膜外麻醉属于一种重要麻醉方式,不仅起效快、麻醉效果理想,且患者术后恢复较快,在骨科手术围手术期得到了广泛应用。本研究旨在探讨腰麻-硬膜外麻醉对老年股骨远端骨折患者肺部感染及认知功能的影响。方法选择2014-10-01-2018-04-01武陟县人民医院择期采取内固定术治疗的老年股骨远端骨折患者112例为研究对象,依据患者采取麻醉方式的不同分为试验组与对照组,各56例。对照组采取全身麻醉,试验组采取腰麻联合硬膜外麻醉。比较两组术后肺部感染率,对比两组术前、术后12h、1d和3d认知功能评分(mini mental state examination scale,MMSE)及术后1d、3d和5d的疼痛程度评分(visual analogue scale,VAS)。结果试验组术后肺部感染率为1.79%,低于对照组的14.29%,χ~2=4.350,P=0.037。试验组术后12hMMSE评分为(26.29±0.68)分,高于对照组的(24.53±0.76)分,t=12.915,P<0.001;试验组术后1d MMSE评分为(27.32±0.57)分,高于对照组的(25.04±0.69)分,t=19.064,P<0.001;试验组3dMMSE评分为(28.96±0.52)分,高于对照组的(27.13±0.64)分,t=16.607,P<0.001。试验组术后1dVAS评分为(3.60±1.27)分,低于对照组的(4.54±1.62)分,t=3.417,P=0.001;试验组术后3dVAS评分为(2.51±1.04)分,低于对照组(3.20±1.38)分,t=2.988,P=0.004;试验组术后5d VAS评分为(1.24±0.82)分,低于对照组的(2.16±0.97)分,t=5.420,P<0.001。结论对接受内固定术治疗的老年股骨远端骨折患者实施腰麻-硬膜外麻醉能减轻患者术后疼痛感,降低肺部感染发生率,且对认知功能影响小。

OBJECTIVE Nternal fixation is an important method for the treatment of distal femoral fracture.The treatment effect is affirmative,but there is some traumatic,and elderly patients have poor tolerance to surgery and anesthesia.The risk of surgery and anesthesia is high.Spinal anesthesia-epidural anesthesia is an important anesthetic method.It not only has a fast onset,but also has an ideal anesthetic effect,and the patient recovers quickly after surgery.It has been widely used in the perioperative period of orthopedic surgery.This study is designed to investigate the effects of spinal anesthesia and epidural anesthesia on pulmonary infection and cognitive function in elderly patients with distal femoral fractures.METHODS A total of 112 elderly patients with distal femoral fractures who underwent internal fixation were selected from Wuyi County People’s Hospital from May 10,2011 to January 20,2011.The patients were divided into experimental group(n=56) and control group(n=56) according to the different anesthesia methods.General anesthesia was used in the control group,and spinal anesthesia combined with epidural anesthesia was used in the experimental group.The postoperative pulmonary infection rate was compared between the two groups.The scores of neurological state examination scale(MMSE) were compared between the two groups at 12 hours,1 day and 3 days after operation.The scores of visual analogue scale(VAS) were compared between the two groups at 1 day,3 days and 5 days after operation.RESULTS The postoperative pulmonary infection rate was 1.79% in the experimental group compared with 14.29% in the control group(χ^2=4.350,P=0.037).The MMSE scores in the experimental group at 12 h,1 dand 3 d were(26.29±0.68),(27.32±0.57) points and (28.96±0.52) points,respectively,higher than(24.53±0.76),(25.04±0.69),and (27.13±0.64) points in the control group(t=12.915,P<0.001;t=19.064,P<0.001;t=16.607,P<0.001).The VAS scores of the experimental group at 1 day,3 days and 5 days after surgery were(3.60±1.27) points,(2.51±1.04) points,and (1.24±0.82) points,respectively,lower than those of the control group(4.54±1.62),(3.20±1.38),and(2.16±0.97)(t=3.417,P=0.001;t=2.988,P=0.004;t=5.420,P<0.001).CONCLUSION Spinal-epidural anesthesia in elderly patients with distal femoral fracture undergoing internal fixation can reduce postoperative pain,reduce the incidence of pulmonary infection,and have little effect on cognitive function.