本刊首页 > 期刊目次 > 高龄全髋关节置换术患者采用全麻和硬膜外麻醉两种手术方式对POCD发生的影响

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高龄全髋关节置换术患者采用全麻和硬膜外麻醉两种手术方式对POCD发生的影响

  • 何旭秀

* 通信作者: 何旭秀, 单位:青海省中医院麻醉科 810000

摘要


目的:研究全麻和硬膜外麻醉两种手术方式对高龄患者术后早期认知能力的影响。

方法:选取2018年6月-2019年6月我院收治的全髋关节置换术患者100例,根据不同麻醉

方法分为对照组50例和观察组50例,其中对照组给予全麻,观察组给予硬膜外;观察比较两组麻醉前(T0)、切皮前(T1)、切皮后(T2)、术后(T3)不同时间心率(HR)、平均动脉压(MAP)及两组术前1d、术后1d、5d的认知能力、MMSE评分,并统计POCD发生率。

结果:观察组T1与T3时MAP、HR指标与T0时比较差异无统计学意义(P>0.05);T2时HR与MAP指标明显较T0明显降低,差异具有统计学意义(P<0.05);对照组T1、T2、T3时MAP与HR明显较T0时明显升高(P<0.05),而观察组T1、T2、T3时的HR、MAP指标明显较同期对照组降低(P<0.05);观察组术后1d、5dMMSE评分与术前1d比较差异无统计学意义(P>0.05);对照组术前1dMMSE评分明显较术后1d降低(P<0.05),而术后5d与术前1dMMSE评分比较差异无统计学意义(P>0.05);观察组与对照组术前1d和术后5dMMSE评分比较差异无统计学意义(P>0.05);术后1d对照组MMSE评分明显较观察组降低,差异具有统计学意义(P<0.05);对照组术后第2dPOCD发生率明显高于观察组(P<0.05);术后5d两组POCD发生率经比较差异无统计学意义(P>0.05)。

结论:行全麻后对高龄患者术后的早期认知能力有明显影响,且术后早期POCD发生率明显高于硬膜外麻醉;硬膜外麻醉安全性高,且术后对高龄患者的早期认知能力无影响,此麻醉

方法值得临床推广使用。

关键词:认知能力;全麻;硬膜外麻醉;MMSE;POCD

ABSTRACT


Objective: To study the effects of two surgical methods, general anesthesia and epidural anesthesia, on early cognitive ability in elderly patients. METHODS: One hundred patients with total hip arthroplasty admitted to our hospital from June 20 to June 2019 were enrolled. According to different anesthesia methods, 50 patients in the control group and 50 patients in the observation group were enrolled. Epidural administration was performed; two groups of pre-anesthesia (T0), pre-cut (T1), post-cut (T2), postoperative (T3) heart rate (HR), mean arterial pressure (MAP), and two groups were observed. The cognitive ability and MMSE score were 1 day before surgery, 1 day and 5 days after surgery, and the incidence of POCD was counted. RESULTS: There was no significant difference in MAP, HR and T0 between T1 and T3 in the observation group (P>0.05). The HR and MAP indexes were significantly lower than T0 at T2, and the difference was statistically significant (P<0.05). The MAP and HR of T1, T2 and T3 in the control group were significantly higher than those in T0 (P<0.05), while the HR and MAP indexes in T1, T2 and T3 of the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in the 1st and 5d MMSE scores between the observation group and the 1st day before operation (P>0.05). The preoperative 1dMMSE score of the control group was significantly lower than that of the 1st postoperative period (P<0.05), and the postoperative 5d and preoperative 1dMMSE There was no significant difference in scores between the two groups (P>0.05). There was no significant difference in the MMSE scores between the observation group and the control group 1 day before and 5 days after operation (P>0.05). The MMSE score of the control group was significantly lower than that of the observation group at 1 day after operation. The difference was statistically significant (P<0.05). The incidence of POCD was significantly higher in the control group than in the observation group (P<0.05). There was no significant difference in the incidence of POCD between the two groups (P>0.05).

Conclusion  : After general anesthesia, the early cognitive ability of elderly patients has a significant effect, and the incidence of early postoperative POCD is significantly higher than epidural anesthesia; epidural anesthesia is safe, and postoperative to elderly patients Early cognitive ability has no effect, and this anesthesia method is worthy of clinical promotion.

Key words: cognitive ability; general anesthesia; epidural anesthesia; MMSE; POCD

引用本文 / How to Cite This Article

何旭秀.高龄全髋关节置换术患者采用全麻和硬膜外麻醉两种手术方式对POCD发生的影响[J]. 国际精神病学杂志, , (): -

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