不同麻醉方式对老年股骨颈骨折患者术后早期认知功能及疼痛的影响

Effects of different anesthesia modes on postoperative early cognitive function and pain in elderly patients with femoral neck fracture

目的观察采用不同麻醉方式对老年股骨颈骨折患者术后早期认知功能和疼痛的影响。方法选取2018年8月至2019年11月于山东省立第三医院手术治疗的老年股骨颈骨折患者60例,随机分为观察组(30例)和对照组(30例)。观察组患者采用腰-硬联合麻醉,对照组患者采用全身麻醉,记录两组患者术后4、8、12 h和24 h的疼痛视觉模拟(VAS)评分,并观察两组患者术前及术后1、3、7 d简易智力状态检查量表(MMSE)评分,两组患者术后认知功能障碍(POCD)发生率及血清NSE、S100B、Aβ的水平。结果与术前相比,两组患者术后MMSE评分均明显下降且差异有统计学意义(P<0.05),术后1、7 d两组患者MMSE评分比较差异无统计学意义(P>0.05),术后3 d两组患者MMSE评分比较差异有统计学意义(P<0.05)。术后各时间点两组患者POCD发生率比较,差异无统计学意义(P>0.05);术后8、12 h两组患者的VAS评分比较差异有统计学意义(P<0.05),术后4、24 h两组患者的VAS评分比较差异无统计学意义(P>0.05)。结论无论是全身麻醉还是腰-硬联合麻醉,对老年股骨颈骨折患者术后早期认知功能均有不同程度的影响,但与全身麻醉相对比,腰-硬联合麻醉可降低老年股骨颈骨折患者POCD的发生率,且镇痛效果更佳。

Objective To observe the effect of different anesthesia modes on postoperative early cognitive function and pain in elderly patients with femoral neck fracture.Methods A total of 60 elderly patients with femoral neck fracture operated in Shandong Provincial Third Hospital from August 2018 to November 2019 were selected and randomly divided into observation group(30 cases)and control group(30 cases).The patients in the observation group adopted the combined spinal-epidural anesthesia(SE)and the patients in the control group were given the general anesthesia(GA).The pain Visual Analogue Scale(VAS)score at postoperative 4,8,12,24 h in the two groups were recorded,and the scores of the Mini-Mental State Examination(MMSE)before operation and on postoperative 1,3,7 d were observed,as well as the incidence rate of postoperative cognitive defect(POCD)and serum levels of NSE,S100B and Aβwere also observed in the two groups.Results Compared with before operation,the postoperative MMSE scores of the two groups were significantly decreased and the difference was statistically significant(P<0.05),the MMSE score on postoperative 1,7 d had no statistical difference between the two groups(P>0.05),and the MMSE score on postoperative 3 d had statistically significant difference between the two groups(P<0.05);there was no statistically significant difference in the POCD incidence rate at each time point after operation between the two groups(P>0.05).The VAS score at postoperative 8,12 h had statistically significant difference between the two groups(P<0.05),which at postoperative 4,24 h had no statistically significant difference between the two groups(P>0.05).Conclusion Both the general anesthesia and combined spinal-epidural anesthesia have different degress of effects on postoperative early cognitive function in the elderly patients with femoral neck fracture,but compared with the general anesthesia,the combined spinal-epidural anesthesia can reduce the incidence rate of POCD in the elderly patients with femoral neck fracture,moreover has better analgesic effect.