两种不同麻醉方法对老年患者股骨头置换术后认知功能障碍的分析(1)
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[摘要] 目的:探讨全麻与腰-硬联合麻醉对老年患者股骨头置换术后认知功能的影响。方法:将60例65岁以上择期行股骨头置换术的患者随机分为两组,全麻组(Ⅰ组)静注芬太尼、丙泊酚、罗库溴铵快速诱导插管,用瑞芬太尼[0.05～0.20 μg/(kg·min)]和丙泊酚[3～6 mg/(kg·h)]持续输注维持麻醉;腰-硬联合麻醉组(Ⅱ组)选择L3～4椎间隙行腰-硬联合穿刺,蛛网膜下腔推注0.5%布比卡因1.0～1.8 ml,必要时硬膜外追加1.6%利多卡因,辅用咪唑1～2 mg或芬太尼50～100 μg。两组麻醉前及术后1、4、8、24 h应用MMSE测试方法评定其认知功能。结果:38例出现术后精神功能障碍,两组总发生率为63.3%。与术前比较,两组患者术后1 h MMSE值均明显降低(P<0.05)。两组各时间点MMSE比较,差异无统计学意义(P>0.05)。结论:全麻与腰-硬联合麻醉两种麻醉方法对老年患者股骨头置换术后认知功能障碍的影响无显著差异。
[关键词] 老年患者;术后认知功能;腰-硬联合麻醉;全程静脉麻醉
[中图分类号] R614[文献标识码]A [文章编号]1673-7210(2010)05(b)-023-03
Analysis of two different anesthesia in the postoperative cognitive dysfunction of elderly patients underwent femoral head replacement
XIAO Huaxin, XU Youfang
(Department of Anesthesia, Dafeng Hospital of Chaoyang District, Shantou City, Shantou 515154, China)
[Abstract] Objective: To explore and spinal anesthesia-epidural anesthesia in elderly patients with femoral head replacement for postoperative cognitive function. Methods: 60 cases aged older than 65 years of selective line of the femoral head arthroplasty patients were randomly divided into two groups, general anesthesia group (group Ⅰ) performed intravenous injection of Fentanyl, Propofol, Rocuronium Bromide rapid induction of intubation, with Remifentanil [0.05-0.20 μg/(kg·min)] and Propofol [3-6 mg/(kg·h)] continuous infusion to maintain anesthesia; spinal-epidural anesthesia group (group Ⅱ) selected L3-4 intervertebral lumbar-epidural puncture, subarachnoid Bupivacaine 0.5% for 1.0-1.8 ml, if necessary, an additional 1.6% epidural Lidocaine was used, complemented with 1-2 mg Imidazole or 50-100 μg Fentanyl. MMSE test was applied in the two groups before anesthesia and 1, 4, 8 and 24 h after surgery to assess the cognitive function. Results: 38 cases of postoperative mental dysfunction occurs, the overall incidence of the two groups was 63.3%. Compared with preoperative MMSE values, the postoperative 1 h MMSE values of the two groups were significantly lower (P<0.05). The two groups at each time point showed no significant difference in MMSE (P>0.05). Conclusion: The impact of anesthesia and spinal-epidural anesthesia has no difference in cognitive dysfunction of elderly patients after femoral head replacement.
[Key words] Elderly patients; Postoperative cognitive function; Waist-hard combined anaesthesia; Total intravenous anesthesia ......
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