轻比重腰麻对老年髋关节置换术患者应激指标和术后认知功能的影响

EFFECT OF LIGHT SPECIFIC GRAVITY SPINAL ANESTHESIA ON STRESS INDEX AND POSTOPERATIVE COGNITIVE FUNCTION IN ELDERLY PATIENTS UNDERGOING HIP REPLACEMENT

目的探讨轻比重腰麻对老年髋关节置换手术患者应激指标、术后认知功能的影响。方法前瞻性选取88例于该院拟实施髋关节置换手术的老年患者,随机分为腰麻组和全麻组,各44例;比较二组患者麻醉前后不同时间点的血流动力学指标、手术前后患者血清去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)、血糖(GLU)、简易精神状态量表(MMSE)及麻醉相关不良反应。结果在T0~T2时间点监测,腰麻组和全麻组患者的MAP、HR、SpO_(2)监测值差异均无统计学意义(均P>0.05);术前腰麻组和全麻组NE、E、Cor及GLU值差异均无统计学意义(均P>0.05),术后2h腰麻组血清NE、E、Cor水平均低于全麻组(均P<0.05);术前腰麻组和全麻组MMSE评分差异无统计学意义(P>0.05),术后腰麻组MMSE评分高于全麻组(P<0.05);腰麻组患者的不良反应发生率9.09%低于全麻组的25.00%(P<0.05)。结论老年髋关节置换手术患者采用轻比重布比卡因实施单侧腰麻相对于全麻,有利于减轻手术应激反应、对患者术后认知功能影响更小、麻醉相关不良反应发生率更低。

Objective To investigate the effect of light specific gravity lumbar anesthesia on stress index and postoperative cognitive function in elderly patients with hip replacement surgery.Methods A prospective study was performed in eighty eight elderly patients who underwent hip replacement surgery in Dezhou People’s Hospital.They were randomized divided into 44 patients in the spinal anesthesia group and the general anesthesia group.The hemodynamic parameters and operation at different time points before and after anesthesia, serum norepinephrine(NE),adrenaline(E),cortisol(Cor),blood glucose(GLU),simple mental state scale(MMSE) and anesthesia-related adverse reactions before and after the patients were compared between the two groups.Results At T0~T2,there was no significant difference in the MAP,HR,and SpO_(2) monitoring values in the spinal anesthesia group and the general anesthesia group(P>0.05).There was no significant difference in serum NE,E,Cor and GLU between lumbar and general anesthesia before operation(P>0.05).The serum NE,E,Cor level of patients in lumbar anesthesia group was lower than that in general anesthesia group(P<0.05).Preoperatively, there was no significant difference in MMSE scores between the lumbar and general anesthesia group(P>0.05).The MMSE score of patients in lumbar anesthesia group was higher than that in general anesthesia group(P<0.05),and the incidence of adverse reactions in lumbar anesthesia group was 9.09%,lower than that in general anesthesia group(P<0.05).Conclusion In elderly patients undergoing hip replacement surgery, unilateral spinal anesthesia with light-weight bupivacaine is effective in reducing surgical stress response, less impact on postoperative cognitive function, and lower incidence of anesthesia-related adverse reactions.