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《全身麻醉和硬膜外麻醉對(duì)老年骨科手術(shù)患者術(shù)后短期認(rèn)知功能的影響.pdf》由會(huì)員上傳分享,免費(fèi)在線閱讀,更多相關(guān)內(nèi)容在行業(yè)資料-天天文庫。
1、·1704·現(xiàn)代生物醫(yī)學(xué)進(jìn)展www.shengwuyixue.eomProgressinModernBiomedicineVoL14NO.9MAR.2014doi:10.13241/j.cnki.pmb.2014.09.026全身麻醉和硬膜外麻醉對(duì)老年骨科手術(shù)患者術(shù)后短期認(rèn)知功能的影響莫桂熙劉奕君莫堅(jiān)梁廣彬張良清(廣東醫(yī)學(xué)院附屬醫(yī)院麻醉科廣東湛江524001)摘要目的:探討全身麻醉和硬膜外麻醉對(duì)老年骨科手術(shù)患者術(shù)后短期認(rèn)知功能的影響。方法:按隨機(jī)數(shù)字方式將2010年3月至2013年5月收治的全麻骨科手
2、術(shù)老年患者64例分為兩組,全身麻醉組(32例)給予全身麻醉進(jìn)行手術(shù),硬膜外麻醉組(32例)給予硬膜外麻醉進(jìn)行手術(shù),對(duì)比分析兩組觀察麻醉前后動(dòng)脈血壓與心率,睜眼、拔管及應(yīng)答時(shí)間,術(shù)后6、12、24、72h的MMSE評(píng)分差異,并統(tǒng)計(jì)術(shù)后POCD的發(fā)生情況。結(jié)果:兩組的年齡、體重、麻醉時(shí)間、受教育時(shí)間、出血量等一般臨床資料均無明顯差異(P>0.05);兩組麻醉前、麻醉后術(shù)前、手術(shù)0.5h及手術(shù)結(jié)束時(shí)動(dòng)脈血壓和心率差異均不顯著(P>0.05);全身麻醉組的睜眼、拔管及應(yīng)答時(shí)間分別為(30.3±10.5)min
3、、(30_3±7.8)min、(33.2±9.6)min;膜外麻醉組的睜眼、拔管及應(yīng)答時(shí)間分別為(30.6±l1.6)min、(30.1±6.6)min、(34-3±8.5)min,兩組差異不顯著(P>0.05);全身麻醉組麻醉前MMSE評(píng)分為29.2±1.5,而膜外麻醉組麻醉前MMSE評(píng)分為29.1±1.0,差異不顯著(P>0.05);麻醉后,兩組的MMSE評(píng)分均出現(xiàn)先減少后恢復(fù)的變化,膜外麻醉組麻醉后24h時(shí)的MMSE評(píng)分28.7±1.0明顯高于全身麻醉組的27.3±0.8(t=-5.491,P=
4、0.000<0.05);全身麻醉組麻醉后6h和12hPOCD的發(fā)生率均明顯高于膜外麻醉組的(P<0.05),而兩組在麻醉后24h開始POCD的發(fā)生率無明顯差異(P>O.05)。結(jié)論:全身麻醉對(duì)老年骨科手術(shù)患者術(shù)后短期認(rèn)知功能的影響明顯大于硬膜外麻醉。關(guān)鍵詞:全身麻醉;硬膜外麻醉;術(shù)后認(rèn)知功能障礙;認(rèn)知功能中圖分類號(hào):R614,R68文獻(xiàn)標(biāo)識(shí)碼:A文章編號(hào):1673.6273(2014)09.1704—05PostoperativeShort—termCognitiveFunctioninElderly
5、OrthopedicPatientsTreatingwithGeneralAnesthesiaandEpidura1AnesthesiaMOGui-xi,LlUYi-jun,MOJian,LIANGGuang-bin,ZHANGLiang-qing(Departmentofanesthesiology,AffiliatedHospitalofGuangdongMedicalCollege,Zhanjiang,Guangdong,524001,China)ABSTRACTObjective:Tostud
6、ythepostoperativeshort—termcognitivefimctionofthegeneralanesthesiaandepiduralanesthesiainelderlypatientswiththeorthopedicdisease.Methods:64elderlypatientsMarch2010toMay2013withgeneralanesthesiaweredividedintotwogroupsbywayofrandomNumbers,thegeneralanest
7、hesiagroup(32cases)weregivengeneralanesthesiasurgery,epiduralanesthesiagroup(32cases)weregivenepiduralanesthesiasurgery,beforeandafteranesthesiaarterialbloodpressureandheartrate,thetimeofopen,tubedrawingandreply,theMMSEscoreofpostoperative6,12,24,72hwer
8、econtrastivelyanalysis.Results:twogroupsofage,weight,anesthesiatime,educationtime,bloodloss,suchasgeneralclinicaldatahadnoobviousdiference(P>0.05);beforeanesthesia,afteranesthesiapreoperative,0.5handsurgeryattheendofthearterialbl