中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (35): 6514-6517.doi: 10.3969/j.issn.1673-8225.2011.35.013

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硬膜外镇痛与静脉镇痛对老年下肢关节置换及植入物内固定治疗后早期认知功能的影响

王世英，孔  玲，毕光焰，魏光武   

  1. 江汉大学第二附属医院麻醉科，湖北省武汉市430050
  • 收稿日期:2011-06-07 修回日期:2011-07-02 出版日期:2011-08-27 发布日期:2011-08-27
  • 作者简介:王世英，女，1962年生，湖北省通山县人，汉族，1985年江汉大学毕业，主治医师，主要从事麻醉镇痛研究。 lmh061127@163.com wangshi88@qq.com

Effects of epidural analgesia and intravenous analgesia on early postoperative cognitive dysfunction after limb orthopedics surgery in the elderly

Wang Shi-ying, Kong Ling, Bi Guang-yan, Wei Guang-wu   

  1. Department of Anesthesiology, Second Affiliated Hospital of Jianghan University, Wuhan  430070, Hubei Province, China
  • Received:2011-06-07 Revised:2011-07-02 Online:2011-08-27 Published:2011-08-27
  • About author:Wang Shi-ying, Attending physician, Department of Anesthesiology, Second Affiliated Hospital of Jianghan University, Wuhan 430070, Hubei Province, China lmh061127@163.com, wangshi88@qq.com

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622

被引次数

31

摘要：

背景：术后认知功能障碍与老年人术后并发症的发生及死亡率密切相关。设定相同麻醉条件下硬膜外镇痛比静脉镇痛对老年患者下肢关节置换及内固定后早期认知功能的影响较小。
目的：比较两种不同的镇痛方法对老年患者下肢骨科手术后早期认知功能的影响。
方法：60例拟行择期下肢手术的老年患者，随机接受椎管内麻醉继以术后静脉镇痛或以硬膜外镇痛。
结果与结论：术后认知功能障碍发生率静脉镇痛组为47%(14/30)，硬膜外镇痛组为30% (9/30例)，两组间差异非常显著(P < 0.01 )。Logistic回归分析显示受教育年限短和髋关节置换术是发生术后早期认知功能障碍的独立危险因素。结果表明，老年患者在下肢关节置换及内固定后早期有38%的患者发生了认知功能障碍，且硬膜外镇痛较静脉镇痛发生术后认知功能障碍明显降低。受教育年限短和髋关节置换本身是术后早期认知功能障碍的危险因素。

关键词: 认知障碍, 老年人, 麻醉与镇痛, 静脉镇痛, 硬膜外镇痛, 回归分析

Abstract:

BACKGROUND: Postoperative cognitive dysfunction (POCD) is being recognized as a complication contributing to perioperative morbidity and mortality of the elderly. We hypothesized that the use of postoperative epidural analgesia would be associated with less incidence of POCD when compared with postoperative intravenous analgesia after limb orthopedics surgery in the elderly.
OBJECTIVE: To compare the effects of epidural analgesia and intravenous analgesia on early postoperative cognitive dysfunction after limb orthopedics surgery in the elderly.
METHODS: Sixty aged patients undergoing elective limb orthopedics surgery were randomly allocated to receive either epidural anesthesia with postoperative intravenous analgesia or epidural anesthesia with postoperative epidural analgesia.
RESULTS AND CONCLUSION: POCD occurred in 14/30 patients (47%) in the intravenous analgesia group and in 9/30 patients (30%) in the epidural analgesia group. There was a significant difference between the two groups (P < 0.01). Logistic regression analysis showed that short duration of education and total hip arthroplasty were independent risk factors for the occurrence of early POCD. The results indicated that POCD occurred in 38% of the elderly patients undergoing limb orthopedics surgery and the epidural analgesia group had less negative effect on early POCD. Short duration of education and operation of total hip arthroplasty were risk factors for early POCD.

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