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 fractures surgery

目的观察腰硬联合麻醉(CSEA)对老年下肢骨折手术患者应激反应、术后认知功能的影响。方法将我院2018年1月至2019年6月收治的100例下肢骨折老年患者根据麻醉方案不同分为对照组和观察组,各50例。对照组采用全身麻醉(GA),观察组采用CSEA。比较两组的麻醉效果、血流动力学指标、应激水平及认知功能。结果观察组的镇静评分、感觉阻滞维持时间、运动阻滞维持时间和术后镇痛时间均优于对照组(P<0.05)。T1、T2、T3时,观察组的MAP、CVP、SVV、RR均优于对照组(P<0.05)。麻醉后,两组的Cor、ADR水平均升高,但观察组低于对照组(P<0.05)。术后6、24 h,观察组的MMSE、CAM评分均优于对照组(P<0.05)。结论老年下肢骨折手术更适合采用CSEA,有助于减少血流动力学改变和应激反应,提高麻醉效果,减轻认知功能障碍。

Objective To observe the effects of combined spinal and epidural anesthesia(CSEA)on stress response and postoperative cognitive function in elderly patients with lower limb fractures surgery.Methods A total of 100 elderly patients with lower limb fractures admitted in our hospital from January 2018 to June 2019 were divided into control group and observation group according to different anesthesia regimen,with 50 cases in each group.The control group was given general anesthesia(GA),and the observation group was given CSEA.Anesthesia effect,hemodynamics parameters,stress level and cognitive function were compared between the two groups.Results The sedation score and maintenance time of sensory block,motor block and postoperative analgesia time in the observation group were better than those in the control group(P<0.05).MAP,CVP,SVV and RR in the observation group were better than those in the control group at T1,T2 and T3(P<0.05).After anesthesia,the levels of Cor and ADR in both groups increased,but those in the observation group were lower than the control group(P<0.05).At 6 and 24 h after operation,the MMSE and CAM scores in the observation group were better than those in the control group(P<0.05).Conclusion CSEA is more suitable for lower limb fractures surgery in the elderly,which is helpful to reduce hemodynamic changes and stress response,improve anesthesia effect and relieve cognitive dysfunction.