腰硬联合麻醉对老年下肢骨折手术患者疼痛程度和认知功能影响

Effect of combined spinal and epidural anesthesia on pain and cognitive function in elderly patients with lower limb fracture

目的分析腰硬联合麻醉对老年下肢骨折手术患者疼痛程度和认知功能影响。方法选取杭州市大江东医院2016年1月至2018年1月收治的老年下肢骨折手术患者82例,采用随机数字表法分为对照组和观察组,每组41例。对照组患者采用全身麻醉,观察组患者采用腰硬联合麻醉,分析两种麻醉的临床效果。结果观察组患者麻醉起效时间[(5.69±2.00)min]、感觉阻滞起效时间[(32.65±2.59)min]及阻滞持续时间[(98.21±10.14)min]均短于对照组(t=5.646、19.576、22.613,均P<0.05)。术前,两组患者视觉模拟评分(VAS)评分、简易智力状态检查量表(MMSE)评分比较,差异均无统计学意义(t=0.093、0.056,均P>0.05)。术后1 d、3 d、7 d时,观察组患者VAS评分低于对照组(t=2.118、1.718、5.372,均P<0.05),MMSE评分均高于对照组(t=6.175、4.628、3.078,均P<0.05),术后14 d时,观察组患者VAS评分低于对照组(t=5.582,P<0.05),MMSE评分与对照组比较,差异无统计学意义(t=0.023,P>0.05)。观察组患者不良反应发生率和术后认知功能障碍发生率分别为4.88%、12.20%,对照组分别为29.27%、31.71%;观察组患者不良反应发生率和术后认知功能障碍发生率均低于对照组,差异均有统计学意义(χ2=8.613、4.556,均P<0.05)。结论腰硬联合麻醉可减轻老年下肢骨折手术患者术后疼痛,促进患者认知功能的恢复,降低不良反应和术后认知功能障碍发生率。

Objective To analyze the effect of combined spinal-epidural anesthesia on the degree of pain and cognitive function in elderly patients with fracture of lower extremity.Methods From January 2016 to January 2018,82 elderly patients with lower extremity fracture treated in Dajiangdong Hospital of Hangzhou were randomly divided into control group and observation group according to the random digital table method.The patients in the control group were treated with general anesthesia,and the patients in the observation group were treated with combined spinal and epidural anesthesia.The anesthesia effects of the two groups were analyzed.Results The onset time of anesthesia and sensory block,and duration of sensory block in the observation group were(5.69±2.00)min,(32.65±2.59)min and(98.21±10.14)min,respectively,which were shorter than those in the control group(t=5.646,19.576,22.613,all P<0.05).Before operation,there were no statistically significant differences in VAS score and MMSE score between the two groups(t=0.093,0.056,all P>0.05).On the 1st day,3rd day and 7th day after operation,the VAS scores in the observation group were lower than those in the control group(t=2.118,1.718,5.372,all P<0.05).The scores of MMSE in the observation group were significantly higher than those in the control group(t=6.175,4.628,3.078,all P<0.05).The VAS score in the observation group was lower than that in the control group on the 14th day after operation(t=5.582,P<0.05),and there was no statistically significant difference in MMSE score between the two groups(t=0.023,P>0.05).The incidences of adverse reaction and postoperative cognitive dysfunction in the observation group were 4.88%and 12.20%,respectively,which were significantly lower than those in the control group(29.27%and 31.71%)(χ2=8.613,4.556,all P<0.05).Conclusion Combined spinal-epidural anesthesia can relieve postoperative pain,promote the recovery of cognitive function,and reduce the incidence of adverse reactions and postoperative cognitive dysfunction in elderly patients with lower limb fracture.