不同麻醉方式对老年髋关节置换术后谵妄、苏醒期躁动及认知功能的影响

Effects of different anesthesia methods on delirium,restlessness and cognitive function after hip joint replacement in elderly patients

目的探讨不同麻醉方式对老年髋关节置换术后谵妄、苏醒期躁动及认知功能的影响。方法选取2018年6月~2020年6月我院行老年髋关节置换术患者65例作为研究对象,按随机数字表法将研究对象分为对照组和观察组。观察组31例患者采用硬膜外复合全身麻醉,对照组34例患者采用全身麻醉。观察比较两组患者的麻醉效果,术后简易精神状态评价量表(MMSE)评分及谵妄、认知功能障碍(POCD)和苏醒期躁动发生情况。结果(1)观察组麻醉时间及术后睁眼时间、拔管时间、语言陈述时间均短于对照组(P<0.05)。(2)术后1h、术后6h、术后12h、术后24h、术后48h两组患者的MMSE评分较前升高,且观察组评分均高于对照组(P<0.05)。(3)观察组患者术后谵妄和POCD发生率均低于对照组,且观察组患者术后谵妄持续时间短于对照组(P<0.05)。(4)观察组术后苏醒期躁动发生率为35.48%,低于对照组的73.53%,差异有统计学意义(P<0.05)。结论硬膜外复合全身麻醉有助于改善老年髋关节置换术患者术后的认知功能,促进患者意识恢复,减少术后谵妄、认知功能障碍和苏醒期躁动发生,值得临床中推广应用。

Objective To investigate the effects of different anesthesia methods on delirium,restlessness and cognitive function after hip joint replacement in elderly patients.Methods A total of 65 elderly patients undergoing hip joint replacement in our hospital from June 2018 to June 2020 were collected and randomly divided into the control group and the observation group according to the random number table method.The observation group(31 cases)received epidural combined general anesthesia,while the control group(34 cases)received general anesthesia.The anesthesia effect,postoperative simple mental state assessment scale(MMSE)score,delirium,postoperative cognitive dysfunction(POCD)and restlessness during waking period between the two groups were compared.Results(1)The anesthesia time,postoperative eye opening time,extubation time and speech presentation time in the observation group were shorter than those in the control group(P<0.05).(2)MMSE scores in the two groups were increased 1 h,6 h,12 h,24 h and 48 h postoperatively,and those in the observation group were all higher than those in the control group(P<0.05).(3)The incidence of postoperative delirium and POCD in the observation group was lower than that in the control group,and the duration of postoperative delirium in the observation group was shorter than that in the control group(P<0.05).(4)The incidence of postoperative agitation in the observation group was 35.48%,lower than 73.53%in the control group,with statistically significant difference(P<0.05).Conclusion Combined epidural general anesthesia is helpful to improve the cognitive function after hip replacement in the elderly patients,promote the recovery of consciousness,reduce postoperative delirium,cognitive dysfunction and agitation in the recovery period,which is worthy of clinical application.