CSEA与LPSB用于老年髋部骨折患者术中的麻醉效果及对患者认知功能的影响

The Anesthetic Effects of CSEA and LPSB in Elderly Patients Undergoing Hip Fracture Surgery and their Impact on Cognitive Function

【目的】观察腰硬联合麻醉(CSEA)与腰丛-坐骨神经阻滞(LPSB)麻醉用于老年髋部骨折术中的麻醉效果及对患者认知功能的影响。【方法】80例行内固定术治疗的老年髋部骨折患者,随机分为观察组及对照组,每组40例。对照组采用CSEA麻醉,观察组采用LPSB麻醉。比较两组患者手术情况,各时间点血流动力学参数[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO 2)]、应激反应指标[血糖(GLU)、白细胞介素6(IL-6)、皮质醇(COR)],手术前后疼痛程度及认知功能变化,不良事件发生情况。【结果】两组患者手术时间、失血量比较,差异无统计学意义(P>0.05),观察组输液量少于对照组,麻醉起效时间、阻滞持续时间长于对照组(P<0.05)。术中30 min,两组HR、MAP均低于术前与术后1 h(P<0.05),但观察组HR、MAP高于对照组(P<0.05)。术中30 min、术后1 h,两组GLU、IL-6、COR均高于术前,且呈持续升高(P<0.05);但术中30 min、术后1 h,观察组GLU、IL-6、COR低于对照组(P<0.05)。术后,两组疼痛视觉模拟评分法(VAS)评分低于术前,蒙特利尔认知评估量表(MoCA)评分高于术前(P<0.05),且观察组VAS评分低于对照组,MoCA评分高于对照组(P<0.05);两组不良事件总发生率比较,差异无统计学意义(P>0.05)。【结论】LPSB用于老年髋部骨折患者手术中,较CSEA的麻醉效果更佳,更利于稳定血流动力学指标,减轻应激反应,对患者认知功能影响较小,且无明显不良事件发生,值得临床推广。

【Objective】To observe the anesthetic effects of combined spinal-epidural anesthesia(CSEA)and lumbar plexus-sciatic nerve block(LPSB)in elderly patients undergoing hip fracture surgery and their impact on cognitive function.【Methods】Eighty elderly patients undergoing internal fixation surgery for hip fractures were randomly divided into an observation group and a control group,with 40 patients in each group.The control group received CSEA anesthesia,while the observation group received LPSB anesthesia.The surgical conditions,hemodynamic parameters at various time points[heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO 2)],stress response indicators[glucose(GLU),interleukin-6(IL-6),cortisol(COR)],pain levels before and after surgery,cognitive function changes,and adverse events were compared between the two groups.【Results】There were no statistically significant differences in surgery time and blood loss between the two groups(P>0.05).However,the observation group had lower infusion volumes,longer anesthesia onset times,and longer block duration compared to the control group(P<0.05).At 30 minutes intraoperatively,both groups showed lower HR and MAP than preoperatively and at 1 hour postoperatively(P<0.05),with the observation group having higher HR and MAP than the control group(P<0.05).The GLU,IL-6,and COR levels at 30 min intraoperatively and 1 hour postoperatively were higher than those before operation in both groups,which showed a continuous increase(P<0.05).However,the observation group had lower GLU,IL-6,and COR levels than the control group at these time points(P<0.05).Postoperatively,both groups had lower visual analog scale(VAS)pain scores and higher Montreal Cognitive Assessment(MoCA)scores than preoperatively(P<0.05),with the observation group showing lower VAS and higher MoCA scores than the control group(P<0.05).There was no statistically significant difference in the overall incidence of adverse events between the two groups(P>0.05).【Conclusion】LPSB offers better anesthetic effects than CSEA for elderly patients undergoing hip fracture surgery.It helps stabilize blood circulation,reduces stress responses,has a smaller impact on cognitive function,and does not result in significant adverse events,which makes it suitable for clinical use.