腰硬联合麻醉与硬膜外麻醉在老年股骨颈骨折防旋股骨近端髓内钉内固定患者中的效果对比

Effects of Combined Lumbar and Epidural Anesthesia on the Anesthetic Effect,Cognitive Function and Stress Response in Elderly Patients with Proximal Femoral Nail Fixation for Femoral Neck Fracture

目的探讨腰硬联合麻醉对老年股骨颈骨折防旋股骨近端髓内钉内固定患者的麻醉效果、认知功能及应激反应的影响。方法收集2019年2月至2022年10月在本院就诊的老年股骨颈骨折且行防旋股骨近端髓内钉内固定术治疗患者68例,采用随机数字表法进行分组,即对照组、观察组,均34例。对照组患者采用硬膜外麻醉,观察组患者采用腰硬联合麻醉。统计两组患者麻醉效果、脑电双频指数(bispectral index,BIS)、认知功能、应激反应相关指标、麻醉满意度、术后并发症发生率。结果观察组患者麻醉起效时间、阻滞完善时间短于对照组患者,观察组患者痛觉阻滞时间长于对照组患者,差异均具有统计学意义(t=18.633、26.171、19.215,P<0.001);麻醉前,两组患者BIS评分比较,差异无统计学意义(P>0.05),麻醉后30min,观察组患者BIS评分高于对照组患者,差异具有统计学意义(t=7.990,P<0.001)。麻醉前,两组患者认知功能比较,差异无统计学意义(P>0.05),术前、术后24h、48h,观察组患者认知功能评分高于对照组患者,差异均具有统计学意义(t=6.263、3.593、4.071,P<0.001)。麻醉前,两组患者后应激反应相关指标Cor、NE、BG、Ang-Ⅱ水平比较,差异均无统计学意义(P>0.05),术后10h,两组患者应激反应相关指标Cor、NE、BG、Ang-Ⅱ水平均上升,组间比较,观察组患者应激反应相关指标Cor、NE、BG、Ang-Ⅱ水平均低于对照组患者,差异均具有统计学意义(t=3.953,P<0.001;t=4.741,P<0.001;t=2.649,P=0.010;t=6.247,P<0.001)。观察组患者满意度97.06%显著高于对照组患者满意度79.41%,差异具有统计学意义(2=5.100,P=0.024)。观察组患者术后并发症发生率8.82%显著低于对照组患者并发症发生率35.29%,差异具有统计学意义(2=6.928,P=0.008)。结论腰硬联合麻醉用于老年股骨颈骨折防旋股骨近端髓内钉内固定患者,可改善麻醉效果,降低术后认知功能异常及应激反应异常发生率,还可减少并发症发生率,值得在临床上广泛应用。

Objective To investigate the effects of combined lumbar and epidural anesthesia on anesthesia effect,cognitive function and stress response in elderly patients with proximal femoral nail fixation for femoral neck fracture.Methods A total of 68 elderly patients with femoral neck fracture admitted to our hospital from February 2019 to October 2022 and treated with anti-rotation proximal femur intramedullary nail fixation were collected.Random number table method was used to group them,i.e.,control group and observation group,with 34 cases in both.The control group received epidural anesthesia,and the observation group received combined lumbar and epidural anesthesia.Anesthesia effect,BIS index(BIS),cognitive function,stress response related indexes,satisfaction with anesthesia and incidence of postoperative complications were analyzed in the two groups.Results The duration of anesthesia onset and block completion in observation group was shorter than that in control group,while the duration of pain block in observation group was longer than that in control group,the differences were statistically significant(t=18.633,26.171,19.215,P<0.001).Before anesthesia,there was no significant difference in BIS score between the two groups(P>0.05).30min after anesthesia,BIS score in the observation group was higher than that in the control group,with statistical significance(t=7.990,P<0.001).Before anesthesia,there was no statistically significant difference in cognitive function between the two groups(P>0.05).Before surgery,24h and 48h after surgery,the cognitive function scores of the observation group were higher than those of the control group,with statistically significant differences(t=6.263,3.593,4.071,P<0.001).Before anesthesia,there was no statistical significance in the levels of Cor,NE,BG and Ang-Ⅱof stress response related indexes between the two groups(P>0.05).At 10h after surgery,the levels of Cor,NE,BG and Ang-Ⅱof stress response related indexes in the two groups were increased.The levels of Cor,NE,BG and Ang-Ⅱof stress response in observation group were lower than those in control group,and the differences were statistically significant(t=3.953,P<0.001;t=4.741,P<0.001;t=2.649,P=0.010;t=6.247,P<0.001).The satisfaction of observation group was 97.06%higher than that of control group 79.41%,and the difference was statistically significant(2=5.100,P=0.024).The incidence of postoperative complications in observation group was 8.82%significantly lower than that in control group,which was 35.29%,and the difference was statistically significant(2=6.928,P=0.008).Conclusions Combined lumbar and epidural anesthesia for elderly patients with femoral neck fracture and proximal intramedullary nail fixation can improve the anesthetic effect,reduce the incidence of postoperative cognitive dysfunction and abnormal stress response,as well as reduce the incidence of complications,and is worthy of wide clinical application.