摘要
目的探讨右美托咪定辅助下腰硬联合麻醉和全身麻醉对老年患者股骨头置换术后认知功能的影响。方法选取本院骨科2017年3月至2019年3月收治的拟行人工股骨头置换术的86例股骨头坏死患者为研究对象,采用随机数表法分为对照组和观察组,各43例。对照组行全身麻醉,观察组行腰硬联合麻醉并全程辅以右美托咪定。比较两组患者手术相关指标(手术时间、术中出血量、术后镇痛时间)、手术前后认知功能、POCD发生率、手术前后血清学指标(S-100β、NSE、CRP、TNF-α、IL-6)水平。结果两组手术时间、术中出血量比较差异无统计学意义,观察组术后镇痛时间明显短于对照组(P<0.05)。术前,两组MoCA评分比较差异无统计学意义;术后1、2、48、72 h,观察组MoCA评分均明显高于对照组(P<0.05),观察组POCD发生率为4.65%,显著低于对照组的16.27%(P<0.05)。术前,两组血清S-100β、NSE、CRP、TNF-α、IL-6水平比较差异无统计学意义;术后,观察组S-100β、NSE、CRP、TNF-α、IL-6水平均明显低于对照组(P<0.05)。结论右美托咪定辅助腰硬联合麻醉能提高老年股骨头置换术后患者的认知功能,降低术后认知功能障碍的发生,值得临床推广应用。
Objective To investigate the effect of combined spinal-epidural anesthesia and general anesthesia with dexmedetomidine on the cognitive function of the elderly patients after femoral head replacement.Methods 86 patients with osteonecrosis of the femoral head who were admitted to the Department of Orthopedics of our hospital from March 2017 to March 2019 planned to undergo artificial femoral head replacement were selected as the research subjects.They were divided into the control group and the observation group by random number table method,with 43 cases in each group.The control group underwent general anesthesia,and the observation group underwent combined spinal-epidural anesthesia and supplemented with dexmedetomidine throughout the course.The surgery-related indicators(operating time,intraoperative blood loss,postoperative analgesia time),cognitive function,the incidence of POCD before and after surgery,and serological indicators before and after surgery(S-100β,NSE,CRP,TNF-α,IL-6)level were compared between the two groups.Results There was no significant difference in operation time and intraoperative blood loss between the two groups,and the postoperative analgesia time in the observation group was significantly shorter than that of the control group(P<0.05).Before operation,there was no significant difference in MoCA scores between the two groups;after 1,2,48,and 72 hours,the Mo-CA scores of the observation group were significantly higher than those of the control group(P<0.05),and the incidence of POCD in the observation group was 4.65%,which was significant lower than 16.27%in the control group(P<0.05).Before operation,there was no significant difference in the levels of serum S-100β,NSE,CRP,TNF-α,and IL-6 between the two groups;after surgery,the levels of S-100β,NSE,CRP,TNF-α,and IL-6 in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Dexmedetomidine-assisted combined spinal-epidural anesthesia can improve the cognitive function of elderly patients after femoral head replacement and reduce the incidence of postoperative cognitive dysfunction.It is worthy of clinical application.
作者
李昭庆
LI Zhaoqing(Department of Anesthesiology,Yanggu County Hospital of Traditional Chinese Medicine,Liaocheng,Shandong,252300,China)
出处
《当代医学》
2021年第19期71-73,共3页
Contemporary Medicine
关键词
右美托咪定
股骨头置换术
术后认知功能障碍
Dexmedetomidine
Femoral head replacement
Postoperative cognitive dysfunction
