腰麻和硬膜外麻醉对老年患者骨科手术后短期内认知功能及应激反应的影响对比

Comparative Study on the Effect of Spinal Anesthesia and Epidural Anesthesia on Short Term Cognitive Function and Stress Response in the Elderly Patients after Orthopedic Surgery

目的:对比腰麻(SA)和硬膜外麻醉(EA)对老年患者骨科手术后短期内认知功能及应激反应的影响。方法:选取2019年2月—2021年2月于临沂市中心医院行骨科手术的100例老年患者,根据随机数字表法分为SA组50例和EA组50例,比较两组手术前后简易智能精神状态检查量表(MMSE)评分;术后认知功能障碍(POCD)发生情况;血管紧张素Ⅱ(AngⅡ)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)水平;收缩压(SBP)、舒张压(DBP)、心率(HR)。结果:与术前比较,两组术后3、12、24 h的MMSE评分均降低,EA组术后3、12、24 h的MMSE评分均显著低于SA组,差异均有统计学意义(P<0.05);与EA组POCD发生率(20.00%)比较,SA组(6.00%)显著低,差异有统计学意义(P<0.05);与术前比较,术后两组AngⅡ、Cor、ACTH水平均显著升高,SA组均显著低于EA组(P<0.05);与术前比较,术后两组SBP、DBP、HR均显著降低(P<0.05),但两组间比较差异均无统计学意义(P>0.05)。结论:相较于EA,SA不仅对老年患者骨科手术后短期内认知功能影响更小,而且还可减轻手术应激反应,两者对血流动力学影响相当,值得临床参考。

Objective:To compare the influence of spinal anesthesia(SA)and epidural anesthesia(EA)on short term cognitive function and stress response of the elderly patients after orthopedic surgery.Method:From February 2019 to February 2021,100 elderly patients who underwent orthopedic surgery in Linyi Central Hospital were divided into the group SA(n=50)and the group EA(n=50)according to the random number table method.The mini mental state examination(MMSE)scores before and after operation,the occurrence of post-operative cognitive dysfunction(POCD),the levels of angiotensinⅡ(AngⅡ),cortisol(Cor),adrenocorticotropic hormone(ACTH),systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)in two groups were compared.Result:Compared with the preoperative,the MMSE scores of the two groups decreased at 3,12,24 hours after operation,MMSE scores at 3,12 and 24 hours after operation in group EA were significantly lower than those in group SA(P<0.05);compared with group EA(20.00%),the incidence of POCD in group SA(6.00%)was significantly lower(P<0.05);compared with the preoperative,the levels of AngⅡ,Cor and ACTH in the two groups were significantly increased after operation,and those in the group SA were significantly lower than those in the group EA(P<0.05);compared with the preoperative,SBP,DBP and HR of the two groups after operation were significantly lower,the differences were statistically significant(P<0.05),but the differences between the two groups were not statistically significant(P>0.05).Conclusion:Compared with EA,SA has less effect on short term cognitive function after orthopedic surgery in elderly patients,but also can reduce the stress response of surgery,both of them have a similar effect on hemodynamics,which is worth clinical reference.