腰硬联合麻醉对老年下肢骨折手术患者应激反应、术后认知功能的影响

Effects of combined spinal and epidural anesthesia on stress response and postoperative cognitive function in elderly patients with lower limb fracture surgery

目的探讨腰硬联合麻醉对老年下肢骨折手术患者应激反应、术后认知功能的影响。方法选取在我院接受下肢骨折手术治疗的60例老年患者作为研究对象,根据麻醉方式将其分为对照组(30例,硬膜外麻醉)和观察组(30例,腰硬联合麻醉)。比较两组的麻醉效果、应激反应、术后认知功能及不良反应发生情况。结果观察组的麻醉起效时间、阻滞完善时间、痛觉阻滞持续时间、Bromage评分、麻醉30 min时的BIS均优于对照组(P<0.05)。术后12 h,两组的Cor、NE、BG、Ang-Ⅱ水平均升高,但观察组明显低于对照组(P<0.05)。手术开始时及术后3、7 d,观察组的MMSE评分均高于对照组(P<0.05)。观察组的不良反应总发生率明显低于对照组(P<0.05)。结论在老年下肢骨折手术中,采用腰硬联合麻醉的效果较好,术后应激反应和认知障碍较轻,且安全性高。

Objective To explore the effects of combined spinal and epidural anesthesia on stress response and postoperative cognitive function in elderly patients with lower limb fracture surgery.Methods A total of 60 cases of elderly patients who received lower limb fracture surgery treatment in our hospital were selected as the research objects and divided into control group(30 cases,epidural anesthesia)and observation group(30 cases,combined spinal and epidural anesthesia)according to the anesthesia mode.The anesthesia effect,stress response,postoperative cognitive function and adverse reactions were compared between the two groups.Results The anesthesia onset time,block completion time,pain block duration,Bromage score and BIS at 30 min of anesthesia of the observation group were better than those of the control group(P<0.05).At 12 h after operation,the levels of Cor,NE,BG and Ang-Ⅱin the two groups increased,but those in the observation group were significantly lower than the control group(P<0.05).At the beginning of the operation and 3 and 7 d after the operation,the MMSE scores in the observation group were higher than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion In elderly patients with lower limb fracture surgery,combined spinal and epidural anesthesia can get better effect,lighter postoperative stress response and cognitive impairment,and has a high safety.