硬膜外腔麻醉对老年髋关节置换术患者近远期认知功能及康复效果的影响

Effect of epidural anesthesia on short-term and long-term cognitive function and rehabilitation of the elderly patients undergoing hip arthroplasty

摘要:

目的 探讨硬膜外腔麻醉对老年髋关节置换术患者近远期认知功能及康复效果的影响。方法 选取2018年4月—2021年5月于遵义市第一人民医院接受髋关节置换术的170例老年患者作为研究对象。根据不同麻醉方法将患者分为对照组和研究组，每组85例。对照组采用全身麻醉，研究组实施硬膜外腔麻醉。比较两组手术相关指标、血流动力学、认知功能、应激反应、术后不良反应及术后近远期认知功能障碍（POCD）发生率。结果 两组麻醉时间、出血量、输液量、输血、低血压发生率比较，差异无统计学意义（P >0.05）。两组T₀～T₃时MAP、HR、SpO₂比较，经重复测量设计的方差分析，结果 ①不同时间点间的MAP、HR、SpO₂有差异（P <0.05）；②各组的MAP、HR、SpO₂比较有差异（P <0.05）；③各组MAP、HR、SpO₂变化趋势有差异（P <0.05）。两组T₄～T₆时MMSE评分比较，经重复测量设计的方差分析，结果 ①不同时间点MMSE有差异（P <0.05）；②各组MMSE有差异（P <0.05）；③各组MMSE变化趋势有差异（P <0.05）。两组T₀、T₃～T₅时血清AD、NE、ET、Cor水平比较，经重复测量设计的方差分析，结果 ①不同时间点间的AD、NE、ET、Cor水平有差异（P <0.05）；②各组AD、NE、ET、Cor水平有差异（P <0.05）；③各组AD、NE、ET、Cor变化趋势有差异（P <0.05）。研究组T₆时POCD发生率低于对照组（P <0.05），两组T₇时POCD发生率、术后不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 与全身麻醉相比，硬膜外腔麻醉用于髋关节置换术可保障老年患者术中血流动力学稳定，降低机体应激反应，有助于患者近期认知功能的改善。

Abstract:

Objective To investigate the effect of epidural anesthesia on short-term and long-term cognitive function and rehabilitation in the elderly patients undergoing hip arthroplasty.Methods A total of 170 elderly patients who underwent hip arthroplasty in The First People's Hospital of Zunyi from April 2018 to May 2021 were included in the study. They were randomly divided into control group and study group, with 85 cases in each group. General anesthesia was carried out in the control group, while epidural anesthesia was applied in the study group. The surgery-related variables, hemodynamics, cognitive function, stress response, postoperative adverse reactions and the incidence of short-term and long-term postoperative cognitive impairment (POCD) were compared between the two groups.Results There was no difference in anesthesia time, bleeding volume, infusion volume, blood transfusion rate or incidence of hypotension between the two groups (P > 0.05). The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO₂) were not different between the two groups at T₀ (P > 0.05). The repeated measurement of MAP, HR and SpO₂ at T₁, T₂, and T₃ revealed that these indexes were different among distinct time points (P < 0.05). The MAP, HR and SpO₂ were also different between the two groups (P < 0.05). In addition, the change trends of MAP, HR and SpO₂ were different between the groups (P < 0.05). The scores of Mini-mental State Examination (MMSE) at T₄, T₅ and T₆ were higher in the study group than those in the control group (P < 0.05), while there was no difference in the MMSE score at T₇ between the two groups (P > 0.05). The serum levels of adrenaline (AD), norepinephrine (NE), endothelin (ET) and cortisol (Cor) at T₀ were not different between the two groups (P > 0.05). The repeated measurement of AD, NE, ET, and Cor levels at T₃, T₄ and T₅ revealed that these indexes were different among distinct time points (P < 0.05). The serum levels of AD, NE, ET, and Cor were also different between the groups (P <0.05), and were even lower in the study group. Besides, the change trends of the serum levels of AD, NE, ET, and Cor were different between the two groups (P < 0.05). The incidence of POCD at T₆ in the study group was lower than that in the control group (P < 0.05). However, there was no difference in the incidence of POCD at T₇ or the overall incidence of postoperative adverse reactions between the study group and the control group (P > 0.05).Conclusions Compared with general anesthesia, epidural anesthesia can maintain the hemodynamic stability during the operation, alleviate the stress response, and contribute to the enhancement of short-term cognitive function in the elderly patients undergoing hip arthroplasty.