硬膜外麻醉与全身麻醉对老年骨科手术患者氧耗量、认知功能的影响比较

Comparison of effects of epidural anesthesia and general anesthesia on oxygen consumption and cognitive function in elderly patients undergoing orthopedic surgery

目的 比较硬膜外麻醉与全身麻醉在老年骨科手术患者中的应用效果。方法 根据麻醉方案将2019年1月至2020年6月在我院进行骨科手术的88例老年患者分为对照组和观察组,各44例。对照组行全身麻醉,观察组行硬膜外麻醉。比较两组患者的麻醉效果、氧耗情况、血流动力学指标、苏醒质量及认知功能。结果 观察组的Ramsay镇静评分高于对照组,感觉阻滞维持时间、运动阻滞维持时间长于对照组,VAS评分低于对照组(P<0.05)。两组麻醉10、30、60 min的VO_(2)、VCO_(2)均高于麻醉前,DO_(2)均低于麻醉前(P<0.05);观察组麻醉10、30、60 min的VO_(2)、VCO_(2)低于对照组,DO_(2)高于对照组(P<0.05)。麻醉30 min,两组的HR均高于麻醉前,MVP、CVP均低于麻醉前(P<0.05);观察组麻醉30 min、术后10 min的HR低于对照组,MVP、CVP高于对照组(P<0.05)。观察组的唤醒睁眼时间、拔管时间、意识恢复时间均短于对照组,POCD发生率低于对照组(P<0.05)。两组术后6、24、48 h的MMSE评分均低于术前(P<0.05);观察组术后6、24、48 h的MMSE评分高于对照组(P<0.05)。结论 硬膜外麻醉在老年骨科手术患者中的应用效果优于全身麻醉,可提高镇痛、镇静效果,改善氧耗情况,减少术中血流动力学波动,提高苏醒质量,且有利于术后认知功能的恢复。

Objective To compare the application effects of epidural anesthesia and general anesthesia in elderly patients undergoing orthopaedic surgery.Methods A total of 88 elderly patients undergoing orthopaedic surgery in our hospital from January 2019 to June 2020 were divided into control group and observation group according to the anesthesia scheme,with 44 cases in each group.The control group was given general anesthesia,and the observation group was given epidural anesthesia.The anesthetic effect,oxygen consumption situation,hemodynamic indexes,awakening quality and cognitive function were compared between the two groups.Results The Ramsay sedation score of the observation group was higher than that of the control group,the maintenance time of sensory block and motor block were longer than those of the control group,and the VAS score was lower than that of the control group(P<0.05).After 10,30 and 60 min of anesthesia,VO_(2)and VCO_(2)in the two groups were higher than those before anesthesia,while DO_(2)was lower than that before anesthesia(P <0.05);after 10,30 and 60 min of anesthesia,VO_(2)and VCO_(2)in the observation group were lower than those in the control group,while DO_(2)was higher than that in the control group(P<0.05).After 30 min of anesthesia,HR of the two groups was higher than that before anesthesia,while MVP and CVP were lower than those before anesthesia(P<0.05);after30 min of anesthesia and at 10 min after operation,HR of the observation group was lower than that of the control group,while MVP and CVP of the observation group were higher than those of the control group(P<0.05).The time of awakening and opening eye,extubation time and consciousness recovery time of the observation group were shorter than those of the control group,and the incidence of POCD was lower than that of the control group(P<0.05).The MMSE score of the two groups at 6,24 and 48 h after operation was lower than that before operation(P<0.05);the MMSE score of the observation group at 6,24 and 48 h after operation was higher than that of the control group(P<0.05).Conclusion Compared with general anesthesia,epidural anesthesia is more effective in elderly patients undergoing orthopaedic surgery.It can improve the analgesic and sedative effects,ameliorate the oxygen consumption situation,reduce the intraoperative hemodynamic fluctuations,improve the awakening quality,and is conducive to the recovery of postoperative cognitive function.