全身麻醉与腰硬联合麻醉老年下肢骨折术后早期认知功能的影响比较

Comparison of the Effects of General Anesthesia and Combined Spinal epidural Anesthesia on Early Cognitive Function after Lower Limb Frac⁃ture Surgery in the Elderly

目的探讨对老年下肢骨折患者采用全身麻醉与腰硬联合麻醉对早期认知功能的影响。方法选择2021年1月—2022年12月南京市六合区人民医院收治的老年下肢骨折患者60例为研究对象,随机分为对照组(采用全身麻醉,n=30)与观察组(采用腰硬联合麻醉,n=30)。比较两组术中生命体征,检测术前术后超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平评估炎症反应状态,评估麻醉前后视觉模拟法(Visual Analogue Scale,VAS)评分以及简易精神状态评价量表(Mini-Mental State Examination,MMSE)评分。结果观察组麻醉后、切皮时平均动脉压(78.81±6.12)、(79.12±6.25)mmHg,心率(76.05±7.01)、(76.54±6.81)次/min,均高于对照组,差异有统计学意义(t=4.723、4.203、4.401、3.727,P<0.05)。观察组术后hs-CRP、TNF-α水平均低于对照组,差异有统计学意义(P<0.05)。术后6、12、24 h观察组VAS评分低于对照组,MMSE评分高于对照组,差异有统计学意义(P<0.05)。结论对老年下肢骨折采用腰硬联合麻醉术中体征稳定,术后疼痛与炎症反应轻微,可减轻认知损伤。

Objective To explore the effect of general anesthesia and combined spinal-epidural anesthesia on early cognitive function in elderly patients with lower limb fractures.Methods Sixty elderly patients with lower extremity fracture treated in Nanjing Lihe District People's Hospital from January 2021 to December 2022 were selected as the study objects,and were randomly divided into control group(with general anesthesia,n=30)and observation group(with combined lumbar and epidural anesthesia,n=30).Intraoperative vital signs were compared between the two groups.The levels of hypersensitive C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α)before and af⁃ter surgery were used to evaluate the state of inflammation.The Visual Analogue Scale(VAS)score and Mini-Mental State Examination(MMSE)score were evaluated before and after anesthesia.Results The mean arterial pressure(78.81±6.12)mmHg and(79.12±6.25)mmHg,the heart rate(76.05±7.01)times/min and(76.54±6.81)times/min in the observation group were higher than those in the control group,the difference was statistically significant(t=4.723,4.203,4.401,3.727,P<0.05).The levels of hs-CRP and TNF-αin the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).VAS score of observation group was lower than that of control group at 6 h,12 h and 24 h after operation,and MMSE score was higher than that of control group,the difference was statistically significant(P<0.05).Conclusion In the elderly patients with lower extremity fractures,the postoperative signs are stable and the postoperative pain and inflammation are mild,which can reduce the cognitive impairment.