全身麻醉和硬膜外麻醉對(duì)老年骨科患者術(shù)后短期認(rèn)知功能的影響

汪偉　張雪蓮

【摘要】 目的：探討全身麻醉和硬膜外麻醉對(duì)老年骨科患者術(shù)后短期認(rèn)知功能的影響。方法：選取2017年2月-2018年2月入院接受治療的134例老年骨科患者，采用雙色球分組法將患者分為對(duì)照組與觀察組，每組67例。兩組接受不同麻醉方式，對(duì)照組接受全身麻醉，觀察組接受硬膜外麻醉，觀察兩組認(rèn)知障礙情況。結(jié)果：觀察組認(rèn)知障礙發(fā)生率低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組麻醉后蘇醒時(shí)間、應(yīng)答時(shí)間、拔管時(shí)間均早于對(duì)照組，差異均有統(tǒng)計(jì)意義（P<0.05）。結(jié)論：硬膜外麻醉對(duì)于老年骨科患者的認(rèn)知功能影響較小，能有效降低發(fā)生認(rèn)知障礙的風(fēng)險(xiǎn)，值得在臨床上推廣。

【關(guān)鍵詞】 全身麻醉; 硬膜外麻醉; 老年骨科患者; 術(shù)后短期認(rèn)知; 認(rèn)知障礙發(fā)生率; 麻醉效果

doi：10.14033/j.cnki.cfmr.2019.22.010 文獻(xiàn)標(biāo)識(shí)碼 B 文章編號(hào) 1674-6805（2019）22-00-03

【Abstract】 Objective：To explore the effects of general anesthesia and epidural anesthesia on postoperative short-term cognition in elderly orthopaedic patients.Method：A total of 134 patients were admitted to hospital for treatment from February 2017 to February 2018 and divided into the control group and the observation group by the double chromosphere grouping method，67 cases in each group.The patients in the two groups received different anesthesia methods，the patients in the control group received general anesthesia，the patients in the observation group received epidural anesthesia，and the cognitive impairment of the patients in the two groups were observed.Result：Incidence of cognitive impairment in the observation group was lower than that of the control group，and the difference was statistically significant（P<0.05）.The recovery time，response time and extubation time after anesthesia of the observation group were earlier than those of the control group，and the differences were statistically significant（P<0.05）.Conclusion：Epidural anesthesia has relatively less influence on cognitive impairment of elderly orthopedic patients and can effectively reduce the risk of cognitive impairment，which is worthy of clinical promotion.

【Key words】 General anesthesia; Epidural anesthesia; Elderly orthopedic patients; Postoperative short-term cognition; Incidence of cognitive impairment; Anesthetic effect

First-authors address：Yingcheng Peoples Hospital，Yingcheng 432400，China

術(shù)后短期認(rèn)知功能障礙是老年患者在接受骨科手術(shù)后，出現(xiàn)的短暫中樞神經(jīng)系統(tǒng)功能異常的癥狀，也是一種較為常見的術(shù)后并發(fā)癥，患者會(huì)出現(xiàn)記憶力減退、精神萎靡及負(fù)性情緒等表現(xiàn)。相對(duì)于年輕患者而言，老年患者機(jī)體恢復(fù)能力較弱，手術(shù)后發(fā)生認(rèn)知障礙的概率更高，針對(duì)此現(xiàn)象，必須選擇一種合適的麻醉方式，以降低患者發(fā)生認(rèn)知功能障礙的風(fēng)險(xiǎn)[1-3]。在患者接受骨科手術(shù)時(shí)需要進(jìn)行麻醉，麻醉方式可選擇硬膜外麻醉、全身麻醉等[4-5]。為了探究硬膜外麻醉、全身麻醉對(duì)老年骨科患者術(shù)后短期認(rèn)知功能的影響，采用雙色球分組法將納入研究的134例患者均分為兩組，對(duì)照組接受全身麻醉，觀察組接受硬膜外麻醉，將本次研究結(jié)果報(bào)道如下。

1 資料與方法

1.1 一般資料

選取2017年2月-2018年2月入院接受治療的134例老年骨科患者。納入標(biāo)準(zhǔn)：（1）均為老年骨科手術(shù)患者;（2）精神狀況、語(yǔ)言表達(dá)、溝通能力、理解能力尚可。排除標(biāo)準(zhǔn)：（1）患有嚴(yán)重且需要臨床干預(yù)的心臟疾病、肝腎疾病、重要器官衰竭等;（2）患有活動(dòng)性傳染疾病;（3）同時(shí)患有兩種原發(fā)癌;（4）依從性較差;（5）不愿參與研究。采用雙色球分組法將患者分為對(duì)照組與觀察組，每組67例。對(duì)照組男41例，女26例;年齡62～84歲，平均（70.74±2.94）歲。觀察組男35例，女32例;年齡60～85歲，平均（70.34±2.86）歲。筆者將兩組一般資料使用統(tǒng)計(jì)學(xué)軟件進(jìn)行分析，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。本次研究獲得醫(yī)學(xué)倫理會(huì)的支持，患者對(duì)研究?jī)?nèi)容知情，經(jīng)筆者回答患者與家屬疑問(wèn)后，均自愿簽署知情同意書。