椎管内麻醉对老年股骨粗隆间骨折患者术后认知功能的影响

Effect of Intraspinal Anesthesia on Postoperative Cognitive Function in Elderly Patients with Intertrochanteric Fractures of Femur

目的:探讨椎管内麻醉对老年股骨粗隆间骨折患者术后认知功能的影响。方法:选取2020年8月—2023年8月龙南市第一人民医院收治的80例老年股骨粗隆间骨折患者,均行手术治疗,根据麻醉方式不同分为两组,各40例。对照组采用全身麻醉,试验组采用椎管内麻醉。比较两组术后恢复指标及气管插管时(T_(0))、切皮时(T_(1))、术毕(T_(2))、术后30 min(T_(3))血流动力学指标[平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))]水平,比较两组术前及术后1、3 d蒙特利尔认知评估量表(MoCA)评分及并发症发生情况。结果:试验组苏醒时间、拔管时间、恢复室停留时间均短于对照组,差异均有统计学意义(P<0.05)。T_(0),两组MAP、HR、SpO_(2)比较,差异均无统计学意义(P>0.05);T_(1)~T_(3),两组MAP、HR水平均高于T_(0),SpO_(2)水平均低于T_(0),但试验组MAP、HR水平均低于对照组,SpO_(2)水平均高于对照组,差异均有统计学意义(P<0.05)。术后1、3 d,两组MoCA评分均低于术前,但试验组均高于对照组,差异均有统计学意义(P<0.05)。试验组并发症发生率为5.00%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论:椎管内麻醉应用于老年股骨粗隆间骨折患者能提高术后苏醒质量,维持血流动力学稳定性,且对患者术后认知功能影响小,安全性良好。

Objective:To investigate the effect of intrathecal anesthesia on postoperative cognitive function in elderly patients with intertrochanteric fracture of femur.Method:A total of 80 elderly patients with intertrochanteric fracture of femur treated in the Longnan First People's Hospital from August 2020 to August 2023 were selected,all patients underwent surgical treatment,and they were divided into two groups according to different anesthesia methods,with 40 cases in each group.The control group was given general anesthesia and the experimental group was given intrathecal anesthesia.The postoperative recovery indexes and the hemodynamic indexes[mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO_(2))]after intubation(T_(0)),skin resection(T_(1)),after surgery(T_(2)),and 30 min after surgery(T_(3))of the two groups were compared.The scores of the Montreal cognitive assessment scale(MoCA)before,1 and 3 d after surgery and the incidence of complications between the two groups were compared.Result:The recovery time,extubation time and recovery room stay time of experimental group were shorter than those of control group,the differences were statistically significant(P<0.05).T_(0),there were no significant differences in MAP,HR and SpO_(2) between the two groups(P>0.05).T_(1)-T_(3),MAP and HR levels in the two groups were higher than those T_(0),SpO_(2) levels were lower than those T_(0),but MAP and HR levels in experimental group were lower than those in control group,SpO_(2) levels were higher than those in control group,the differences were statistically significant(P<0.05).On the 1 and 3 d after surgery,the MoCA scores in both groups were lower than those before surgery,but those in the experimental group were higher than those in control group,the differences were statistically significant(P<0.05).The complication rate of experimental group was 5.00%,which was lower than 20.00%of control group,the difference was statistically significant(P<0.05).Conclusion:Intrathecal anesthesia in elderly patients with intertrochanteric fracture of femur can improve postoperative recovery quality,maintain hemodynamic stability,and have little effect on postoperative cognitive function,with good safety.