腰硬联合麻醉对老年下肢手术患者MoCA评分及血流动力学的影响

Effect of Combined Epidural Anesthesia on MoCA Score and Hemodynamics in Elderly Patients Undergoing Lower Extremity Surgery

目的分析腰硬联合麻醉对老年下肢手术患者的影响。方法随机选取2020年1月—2023年7月期间扬中市中医院收治的50例老年下肢手术患者为研究对象,按1:1比例随机分为A、B两组,各25例。A组应用腰硬联合麻醉,B组应用全身麻醉。对比两组血流动力学变化、认知功能、不良反应、术后疼痛。结果T1、T2时两组患者的平均动脉压(mean arterial pressure,MAP)低于T0,差异有统计学意义(P<0.05)。A组T1~T3时的心率与T0相比,差异无统计学意义(P>0.05);B组T1、T2时的心率低于T0,T3时的心率高于T1、T2,差异有统计学意义(P<0.05)。A组T1、T2时的MAP和心率均高于B组,差异有统计学意义(P<0.05)。A组术后2、6 h时的数字等级评价法评分低于B组,差异有统计学意义(P<0.05)。两组术后24、72 h的蒙特利尔认知评估量表评分均较术前降低,但A组评分高于B组,差异有统计学意义(P<0.05)。A组不良反应发生率(12.00%)与B组比较(24.00%),差异无统计学意义(χ^(2)=0.542,P>0.05)。结论腰硬联合麻醉用于老年下肢手术,可维持较为稳定的血流动力学,对患者术后认知功能影响较小。

Objective To analyze the influence of combined epidural anesthesia on elderly patients undergoing lower extremity surgery.Methods 50 elderly patients with lower extremity surgery admitted to Yangzhong Hospital of Traditional Chinese Medicine from January 2020 to July 2023 were randomly selected as the study objects and divided into group A and group B according to the 1:1 ratio with 25 cases in each group.Group A received combined epidural anesthesia and Group B received general anesthesia.Hemodynamic changes,cognitive function,adverse reactions and postoperative pain were compared between the two groups.Results The mean arterial pressure(MAP)of the two groups at T1 and T2 were lower than that at T0,and the differences were statistically significant(P<0.05).In group A,there was no statistically significant difference in the heart rate at T1 to T3 compared with T0(P>0.05).In group B,the heart rate at T1 and T2 was lower than that at T0,but the heart rate at T3 and was higher than that at T1 and T2,and the differences were statistically significant(P<0.05).The MAP and heart rate of group A at T1 and T2 were higher than those of group B,and the differences were statistically significant(P<0.05).Numerical Rating Scale score of group A was lower than that of group B at 2 and 6 h after operation,and the differences were statistically significant(P<0.05).Montreal Cognitive Assessment scores of both groups at 24 and 72 h after surgery were lower than those before surgery,but the score of group A was higher than that of group B,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence rate of adverse reactions between group A(12.00%)and group B(24.00%)(χ^(2)=0.542,P>0.05).Conclusion Combined epidural and lumbar anesthesia can maintain relatively stable hemodynamics and have little effect on postoperative cognitive function in elderly patients undergoing lower extremity surgery.