不同麻醉方式对老年患者全膝关节置换术后MMSE评分、精神错乱和深静脉血栓发生的影响

Effects of two different anesthesia methods on MMSE score,mental disorder and deep vein thrombosis in elderly patients after total knee arthroplasty

目的分析不同麻醉方式对老年患者全膝关节置换(total knee arthroplasty,TKA)术后深静脉血栓形成和精神状态的影响。方法选取84例择期行TKA治疗的老年膝关节骨性关节炎患者,分为对照组(全身麻醉)和观察组(腰硬联合麻醉)各42例。比较两组患者手术前后外周血神经生长因子(nerve growth factor,NGF)和脑源性神经营养因子(brain derived neurotrophic factor,BDNF)水平及简易精神状态检查量表(mini mental state examination,MMSE)评分,并记录两组术后深静脉血栓形成和精神错乱的发生情况。结果两组外周血NGF和BDNF水平、MMSE评分均呈现先下降后升高的趋势,且均在术后1 h达最低点,其组间、时点间和组间·时点间交互作用差异有统计学意义(P<0.05),观察组术后3 d内精神错乱和7 d内深静脉血栓发生率均明显低于对照组(P<0.05)。结论对于行TKA治疗的老年膝关节骨性关节炎患者而言,相比全身麻醉,腰硬联合麻醉可有效降低术后深静脉血栓发生率,且对患者术后精神状态的影响较轻。

Objective To analyze the effect of two different anesthesia methods on deep vein thrombosis(DVT)and mental state in elderly patients undergoing total knee arthroplasty(TKA).Methods A total of 84 elderly patients with knee osteoarthritis(KOA)who were treated with TKA were divided into two groups:the control group(general anesthesia,n=42)and the observation group(combined spinal and epidural anesthesia,n=42).The levels of nerve growth factor(NGF)and brain derived neurotrophic factor(BDNF)in peripheral blood and the scores of mini-mental state examination(MMSE)were compared before and after operation,and the occurrence of DVT and mental disorder was recorded.Results The levels of NGF and BDNF in the peripheral blood and the MMSE scores of the two groups were reduced initially and then increased,and both reached the lowest point at 1 h after operation.The differences of interaction between groups,time points,and time points between groups were statistically significant(P<0.05),The incidence of mental disorder within 3 d after operationand DVT within 7 d after operation was significantly lower in the observation group than in the control group(P<0.05).Conclusion Compared with general anesthesia,combined spinal and epidural anesthesia can effectively reduce the incidence of postoperative DVT in elderly patients with KOA treated by TKA,and has a less impact on their mental state.