针药复合麻醉对老年患者人工髋关节置换术麻醉耐受性及术后精神障碍影响的临床研究

Effects of combined acupuncture-drug anesthesia on tolerance and postoperative psychonosema in artificial femoral head replacement of elderly patients

目的观察针药复合麻醉对老年患者人工髋关节置换术麻醉耐受性及术后精神障碍的影响。方法将80例股骨颈骨折的老年患者随机分为治疗组与对照组,每组40例。对照组行微创人工髋关节置换术并予常规药物麻醉,治疗组行微创人工髋关节置换术并予针药复合麻醉。观察术中麻醉药用量、外周血肾上腺皮质激素(皮质醇)水平,以及术后不同时点心率、血压及精神障碍发生情况;随访1年后,观察髋关节功能harris评分的情况。结果 (1)手术期间,两组芬太尼、丙泊酚用量差异均有统计学意义,治疗组明显少于对照组(P<0.05)。(2)两组气管导管拔除前5 min,治疗组收缩压明显低于对照组(P<0.05);气管导管拔出时,治疗组心率和收缩压均明显低于对照组(P<0.05);苏醒后,治疗组心率明显低于对照组(P<0.05)。(3)两组术中外周血皮质醇水平差异无统计学意义(P>0.05)。(4)治疗组、对照组术后精神障碍发生率分别为12.5%、37.5%,组间差异有统计学意义,治疗组明显低于对照组(P<0.05)。(5)组间髋关节功能评分优良率比较,差异无统计学意义(P>0.05)。结论针刺复合麻醉可在不增加髋关节置换手术老年患者应激反应的基础上,明显减少麻醉药物用量及术后并发症(精神障碍)的发生,提高患者的麻醉耐受性。

Objective To observe the effects of combined acupuncture-drug anesthesia on the anesthesia tolerance and postoperative psychonosema in artificial femoral head replacement of elderly patients. Methods 80 elderly patients with femoral neck fracture were randomly divided into the treatment group and control group,40 cases in each group. The control group was treated with minimally invasive artificial femoral head replacement and conventional drug anesthesia,the treatment group was treated with minimally invasive artificial femoral head replacement and combined acupuncture-drug anesthesia. The anesthetic dosage and the level of adrenocorticotropic hormone( cortisol) in peripheral blood were observed during operation,as well as the heart rate and blood pressure at different timepoints and the incidence of postoperative psychonosema. After one-year follow-up,the harris scores on hip joint function were observed. Results(1) During operation,there were statistically significant differences on the dosages of fentanyl and propofol between the two groups,and the dosages in the treatment group were obviously less than those in the control group( P<0.05).(2)5 minutes before tracheal catheter extubation,the systolic pressure of the treatment group was obviously lower than that of the control group( P < 0. 05). At the moment of tracheal catheter extubation,the heart rate and systolic pressure of the treatment group were obviously lower than those of the control group( P<0.05). After recovery,the heart rate of the treatment group was obviously lower than that of the control group( P<0.05).(3)During operation,there was no statistically significant difference on the level of cortisol in peripheral blood between the two groups( P > 0. 05).(4)The incidence rates of postoperative psychonosema were 12.5% in the treatment group and 37.5% in the control group. There was statistically significant difference on the incidence rate between the two groups,and the incidence rate of the treatment group was obviously lower than that of the control group( P<0.05).(5)There was no statistically significant difference on the excellent rate of harris scores on hip joint function between the two groups( P > 0. 05). Conclusion The combined acupuncture-drug anesthesia shows no increase in the stress response of elderly patients with artificial femoral head replacement,based on this,it can obviously reduce the dosage of anesthetics and the occurrence of postoperative complications( psychonosema),and improve the patients' tolerance to anesthesia.