不同麻醉方式对骨科手术患者血流动力学、术后精神状态及认知功能的影响

目的:探讨不同麻醉方式对骨科手术患者血流动力学、术后精神状态及认知功能的影响。方法:选取2016年1月～2018年12月期间我院收治的89例骨科手术患者,根据数字表法将患者随机分为对照组(n=44)和研究组(n=45),对照组给予全身麻醉,研究组给予硬膜外麻醉,比较两组患者围术期指标情况,比较两组患者不同时间点血流动力学、术后精神状态及术后认知功能障碍(POCD)发生率。结果:两组患者术中麻醉时间、术中出血量比较,差异无统计学意义(P0.05);研究组麻醉药物使用量少于对照组,苏醒时间、语言恢复时间短于对照组(P0.05)。两组患者麻醉后术前(T2)时间点平均动脉压(MAP)、心率(HR)均较麻醉前(T1)时间点降低,两组患者手术30 min(T3)、手术结束时(T4)时间点MAP、HR均较T2时间点升高(P0.05),但两组患者T1～T4时间点MAP、HR比较,差异无统计学意义(P0.05)。对照组术后6 h(T5)～术后72 h(T8)时间点、研究组T5～术后24 h(T7)时间点MMSE评分低于T1时间点(P0.05),而研究组T8时间点MMSE评分与T1时间点比较,差异无统计学意义(P0.05);研究组T7、T8时间点MMSE评分高于对照组(P0.05)。研究组T5、术后12 h(T6)时间点POCD发生率均低于对照组(P0.05),两组T7、T8时间点POCD发生率比较,差异无统计学意义(P0.05)。结论:两种麻醉方式均可对骨科手术患者血流动力学、术后精神状态造成一定影响,但硬膜外麻醉对术后精神状态的影响程度相对更轻,同时还可降低POCD发生率,改善围术期部分指标。

Effects of Different Anesthesia Methods on Hemodynamics, Post-operative Mental State and Cognitive Function in Patients Undergoing Orthopaedic Surgery

ABSTRACT Objective: To investigate the effects of different anesthesia methods on hemodynamics, post-operative mental state and cognitive function in patients undergoing orthopaedic surgery. Methods: 89 patients with orthopaedic surgery who were admitted to our hospital from January 2016 to December 2018 were selected, they were randomly divided into control group (n=44) and study group (n=45) according to the digital table method. The control group was given general anesthesia, and the study group was given epidural anesthesia. The perioperative indexes of the two groups were compared. The hemodynamics, post-operative mental state and the incidence of post-operative cognitive impairment (POCD) were compared between the two groups at different time points. Results: There was no significant difference in intraoperative anesthesia time and intraoperative bleeding between the two groups (P>0.05). The use of anesthetics in the study group was less than that in the control group, and the wake-up time and language recovery time were shorter than those in the control group(P<0.05). The mean arterial pressure(MAP) and heart rate (HR) before anesthesia (T2) time point in both groups were lower than those before anesthesia (T1) time point. The MAP and HR at 30 minutes (T3) and at the end of operation (T4) in both groups were higher than those at T2 time point(P<0.05). There was no significant difference in MAP and HR between the two groups at T1-T4 time points(P>0.05). The MMSE score of control group at 6 h after operation (T5) ~72 h after operation (T8) time point and study group at T5 ~24 h after operation (T7) time point were lower than that of at T1 time point(P<0.05). There was no significant difference in MMSE score between T8 time point and T1 time point in the study group(P>0.05). The MMSE scores of T7 and T8 in the study group were higher than those in the control group(P<0.05). The incidence of POCD at T5 and 12 h after operation (T6) time points in the study group was lower than that in the control group(P<0.05). There was no significant difference in the incidence of POCD at T7 and T8 time points between the two groups (P>0.05). Conclusion: Both anesthesia modes can affect the hemodynamics and post-operative mental state of orthopedic surgery patients, but epidural anesthesia has less effect on post-operative mental state, and it can also reduce the incidence of POCD, it can improve some perioperative indicators.