文章摘要
胡丰登,张婷.硬脊膜外腔阻滞复合全身麻醉对髋关节骨折术后认知功能的影响[J].中国临床保健杂志,2018,21(3):349-352.
硬脊膜外腔阻滞复合全身麻醉对髋关节骨折术后认知功能的影响
Effect of epidural anesthesia combined with general anesthesia on postoperative cognitive function in patients with hip fracture
投稿时间:2018-01-15  
DOI:10.3969/J.issn.1672-6790.2018.03.017
中文关键词: 麻醉,全身  麻醉,硬膜外  认知  髋关节  关节内骨折
英文关键词: Anesthesia,general  Anesthesia,epidural  Cognition  Hip joint  Intra-articular fractures 〖FL
基金项目:
作者单位E-mail
胡丰登 浙江永康市第一人民医院麻醉科,321300 ykhufengdeng@126.com 
张婷 湖州师范学院医学院麻醉科  
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中文摘要:
      目的 探讨硬脊膜外腔阻滞复合全身麻醉在髋关节骨折手术中的应用价值及对患者术后认知功能的影响。方法 选取82例髋关节骨折患者为研究对象,行内固定手术或髋关节置换术治疗,以随机数字表法分为对照组41例,观察组41例。对照组采用气管插管全身麻醉,观察组采用硬脊膜外腔阻滞复合气管插管全身麻醉,记录两组麻醉前15 min(T0)、麻醉即刻(T1)、麻醉后30 min(T2)、术后30 min(T3)平均动脉压(MAP)及心率(HR);观察两组患者围术期血流动力学变化,术后认知功能及不良反应发生率。结果 两组T0、T3时HR、MAP比较,差异无统计学意义(P>0.05);T1、T2时,观察组HR、MAP与对照组比较,差异有统计学意义(P<0.05);对照组T1、T2时HR、MAP与T0、T3时对比,差异有统计学意义(P<0.05);两组认知功能术后1 h时,差异无统计学意义(P>0.05),术后4 h、术后8 h,观察组蒙特利尔认知评估量表(MoCA)评分同对照组比较,明显较高,差异有统计学意义(P<0.05);术后不良反应发生率观察组为12.20%,同对照组17.07%比较,差异无统计学意义(P>0.05),均未出现严重不良反应。结论 硬脊膜外腔阻滞复合全身麻醉利于患者术中血流动力稳定,安全性高,且对术后认知功能影响小。
英文摘要:
      Objective To explore the application value of epidural anesthesia combined with general anesthesia in the operation of hip fracture and its influence on postoperative cognitive function.Methods 82 patients with hip fracture were selected as the research objects,and they were treated with internal fixation or hip replacement.They were randomly divided into the control group(41 cases) and the observation group(41 cases).The control group was treated with general anesthesia with tracheal intubation,and the observation group was treated with epidural anesthesia combined with tracheal intubation,the hemodynamic changes,postoperative cognitive function and incidence of adverse reactions were observed in the two groups.Results At T0 and T3,there was no significant difference between the two groups in HR and MAP(P>0.05).At T1 and T2,MAP and HR in the observation group compared with the control group,the difference was statistically significant(P<0.05),compared with T0 and T3 in control group T1 and T2,the difference was statistically significant(P<0.05).There was no significant difference in postoperative cognitive function between the two groups(P>0.05).4 h and 8 h after operation,the MoCA score of the observation group was significantly higher than that of the control group(P<0.05),and the difference was statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 12.20%,compared with 17.07% in the control group,the difference was not statistically significant(P>0.05),there were no serious adverse reactions in bath groups.Conclusion Epidural anesthesia combined with general anesthesia has the quick hemodynamic stability,high safety and little effect on postoperative cognitive function.
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