[1]焦志华,陈 军,范 坤,等.不同麻醉方法对老年患者膝关节置换术后认知功能的影响*[J].陕西医学杂志,2020,49(3):317-320.
　JIAO Zhihua,CHEN Jun,FAN Kun,et al.Effects of different anesthesia methods on cognitive function of elderly patients after knee replacement[J].,2020,49(3):317-320.
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不同麻醉方法对老年患者膝关节置换术后认知功能的影响*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
49
期数:
2020年3期
页码:
317-320
栏目:
临床研究
出版日期:
2020-03-05

文章信息/Info

Title:
Effects of different anesthesia methods on cognitive function of elderly patients after knee replacement
文章编号:
DOI:〖HT5K〗10.3969/j.issn.10007377.2020.03.014
作者:
焦志华; 陈 军; 范 坤; 王爱忠
上海健康医学院附属上海市第六人民医院东院麻醉科(上海201306)
Author(s):
JIAO Zhihua; CHEN Jun; FAN Kun; et al.
Department of Anesthesiology,East Hospital of Shanghai Sixth People's Hospital,Shanghai Health Medical College(Shanghai 201306)
关键词:
膝关节置换;  全身麻醉;  神经阻滞;  腰硬联合麻醉;  术后认知功能障碍;  老年人
Keywords:
Knee joint replacement;  General anesthesia;  Nerve block;  Lumbar epidural anesthesia;  Postoperative cognitive dysfunction;  Aged
分类号:
R614.2
文献标志码:
A
摘要:
目的:探讨不同麻醉方法对老年患者膝关节置换术后早期认知功能的影响。方法:选择老年膝关节置换患者80例,依据不同麻醉方法分为喉罩全麻复合神经阻滞组(H组)和腰硬联合麻醉组(C组)各40例,分别于术前1 d(T0)和术后1 d(T1)、3 d(T2)、7 d(T3)应用简易智能量表(MMSE)评定其认知功能,并在每个时点抽取外周静脉血用ELISA法测定血浆IL-6的含量。结果:术后两组第1、3天MMSE评分与术前(T0)相比具有统计学差异(P<0.05),术后第7天与术前(T0)相比差异无统计学意义(P>0.05)。H组术后1、3 d MMSE评分降低明显(P<0.05),但术后7d H组与C组相比无统计学意义(P>0.05)。两组IL-6的含量与基础值(T0)相比,术后3d明显升高(P< 0.01),峰值出现于手术后24h(T1)。与C组相比,H组IL-6值T1、T2 时间点较高(P<0.01),在T3两组间比较无统计学差异。结论:腰硬联合麻醉较全麻喉罩加神经阻滞对老年患者膝关节置换术后早期认知功能影响轻,POCD发生率低,与远期比较没有统计学差异。
Abstract:
Objective:To investigate the effects of different anesthesia methods on early cognitive function of elderly patients after knee replacement.Methods:80 elderly patients with knee joint replacement were selected and divided into general anesthesia laryngeal mask and nerve block group(group H,n=40)and combined epidural and spinal anesthesia(group C,n=40)according to different anesthesia methods.On the first day before operation(T0 point)and the first day(T1 point)、third day(T2 point)、seventh day(T3 point)after operation,congnitive function was assessed by Mini mental state examination(MMSE).At each time point,the peripheral venous blood was collected and the content of plasma IL-6 was correspondingly measured by ELISA.Results:Compared with the baseline(T0 point),the scores of MMSE in two groupsatT1 and T2 points were increased(P<0.05),but there was no statistical difference at T3 point.Compared with group C,the scores of MMSE at T1 and T2 points in group H were discreased(P<0.05),but there was no statistical difference at T3 point.Compared with the baseline(T0 point)in two groups,the concentrations of IL-6 at T1 and T2 points were increased(P<0.05),and the peak happened at T1 point.Compared with group C,the concentrations of IL-6 at T1 and T2 points were higher in group H(P<0.05),but there was no statistical difference at T3 point.Conclusion:Combined epidural and spinal anesthesia has a lower effect on early cognitive function than general anesthesia laryngeal mask and nerve block after knee replacement in elderly patients,and the incidence of POCD is low,but there are no significant differences in the long run.

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备注/Memo

备注/Memo:
*上海健康医学院种子基金资助项目(HMSF-21-019)
更新日期/Last Update: 2020-03-25