|本期目录/Table of Contents|

[1]郭 瑜,杨奕洁,成 禹,等.地氟醚对老年人行全髋关节置换术后早期认知功能的影响[J].福建医科大学学报,2019,53(04):264-266.
 GUO Yu,YANG Yijie,CHENG Yu,et al.Effects of Desflurane on Early Cognitive Function after Total Hip Replacement in the Elderly Patients[J].Journal of Fujian Medical University,2019,53(04):264-266.
点击复制

地氟醚对老年人行全髋关节置换术后早期认知功能的影响(PDF)
分享到:

《福建医科大学学报》[ISSN:1672-4194/CN:35-1192/R]

卷:
第53卷
期数:
2019年04期
页码:
264-266
栏目:
临床研究
出版日期:
2019-08-31

文章信息/Info

Title:
Effects of Desflurane on Early Cognitive Function after Total Hip Replacement in the Elderly Patients
文章编号:
1672-4194(2019)04-0264-04
作者:
郭 瑜1 杨奕洁1 成 禹2 吴晓丹1
1.福建医科大学 省立临床学院、福建省立医院南院 麻醉科,福州 350001; 2.南京军区福州总医院 麻醉科,福州 350025
Author(s):
GUO Yu1 YANG Yijie1 CHENG Yu2 WU Xiaodan1
1. Department of Anesthesiology, Jinshan Branch of Fujian Provincial Hospital, Provincial Clinic College of Fujian Medical University, Fuzhou 350001, China; 2. Department of Anesthesiology, Fuzhou General Hospital, Fuzhou 350025, China
关键词:
关节成形术置换 老年人 认知障碍 异氟醚/类似物和衍生物
Keywords:
arthroplasty replacement hip aged cognition disorders isoflurane/analogs & derivatives
分类号:
R687.4; R687.42; R741; R971.2
DOI:
-
文献标志码:
-
摘要:
目的 探讨地氟醚静吸复合全麻对比腰硬联合麻醉对老年患者行全髋关节置换术后早期认知功能的影响。 方法 选取行全髋关节置换术的老年患者(年龄>65岁)66例,采取计算机随机序列法将患者分为地氟醚组(D组)和腰硬联合麻醉组(C组)。围术期使用简易智能状态量表(MMSE)评估患者术前1 d及术后1,3,7 d的认知功能; 观察患者术后谵妄的发生率和麻醉满意度。 结果 术后1 d,C组和D组的MMSE评分均较术前明显下降(P<0.05),且D组低于C组(P<0.05)。术后3 d,D组的MMSE评分相较术前仍有下降(P<0.05),但较术后1 d升高(P<0.05); C组的MMSE评分与术前比较,差别有统计学意义(P<0.05),比术后1 d升高(P<0.05),但与D组比较差别无统计学意义(P>0.05)。术后7 d,两组的MMSE评分基本恢复至术前水平,且差别无统计学意义(P>0.05)。D组患者的麻醉满意度明显高于C组(P <0.01)。 结论 老年人行全髋关节置换术,使用地氟醚静吸复合全麻或腰硬联合麻醉,对患者术后认知功能障碍的影响无明显差异。
Abstract:
Objective To compare the effects of desflurane combined anesthesia with combined spinal epidural anesthesia(CSEA)on early postoperative cognitive function in elderly patients undergoing total hip replacement. Methods 66 patients(aged over 65)who underwent the total hip replacement from June 2016 to July 2017 were selected. By computer random sequence method, the patients were randomly divided into desflurane group(group D)and CSEA group(group C). This study adopted MMSE(mini-mental state examination MMSE)to assess patients' cognitive functions during the perioperativeperiod-1 d before surgery, 1 d, 3 d and 7 d after surgery. We also observed the prevalence of postoperative delirium and patient satisfaction with anesthesia. Results The collected data were processed by the method of repeated variance analysis. The results revealed that after operation, the scores of 1 d MMSE in group D and group C were significantly lower than they were before operation(P<0.05), while the score in group D was lower than that in group C(P<0.05). 3 d after the operation, the MMSE scores of group D were still lower than the preoperative level(P<0.05), but were higher than the data of 1 d(P<0.05). However, the scores of these two groups in this period showed no statistical difference. According to the data of 7 d after operation, the scores of two groups basically returned to the preoperative levels, and there was no statistical difference in the incidence of delirium between the two groups(P>0.05). The satisfaction of patients in group D was significantly higher than that in group C(P<0.01). Conclusion There is no significant difference in effects between desflurane anesthesia and CSEA on early postoperative cognitive function in elderly patients undergoing total hip replacement surgery.

参考文献/References:

[1] Hughes C G, Patel M B, Jackson J C, et al. Surgery and anesthesia exposure is not a risk factor for cognitive impairment after major noncardiac surgery and critical illness[J]. Ann Surg, 2017,265(6):1126-1133. [2] Inada E.Postoperative cognitive dysfunction:preface and comments[J].Masui, 2014,63(11):1184-1187. [3] 朱晗月, 李晶晶, 邓立琴, 等. 麻醉因素与代谢综合征老年病人术后认知功能障碍的关系: 异丙酚复合麻醉与七氟醚复合麻醉比较[J]. 中华麻醉学杂志, 2017,8(37):910-913. [4] Silbert B, Evered L, Scott D A, et al. Preexisting cognitive impairment is associated with postoperative cognitive dysfunction after hip joint replacement surgery[J]. Anesthesiology, 2015,122(6):1224-1234. [5] Shu A H, Wang Q, Chen X B. Effect of different depths of anesthesia on postoperative cognitive function in laparoscopic patients:a randomized clinical trial[J]. Curr Med Res Opin, 2015,31(10):1-10. [6] Radtke F M, Franch M, Lendner J, et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction[J]. Br J Anaesth, 2013,110(6):98-105. [7] Larner A J, Mitchell A. The Mini-Mental State Examination(MMSE): update on its diagnostic accuracy and clinical utility for cognitive disorders[M]. Cham, Switzerland: Springer International Publishing, 2017:37-48. [8] Moiler J T, Cluitmans P, Rasmussen L S, et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study[J]. Lancet, 1998,351:857-861. [9] 季 惠, 程志军, 施慧群, 等. 丙泊酚与七氟醚对老年患者术后早期认知功能障碍的影响[J]. 世界临床医药, 2017,38(3):191-195. [10] White S M, Moppett I K, Griffiths R. Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65535 patients in a national dataset[J]. Anaethesia, 2014,69(6):224-230. [11] Zywiel M G, Prabhu A, Permccio A V, et al. The influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty:a systematic review[J]. Clin Orthop Relat Res, 2014,472(5):1453-1466. [12] 樊国平. 两种麻醉方式对老年患者行全髋关节置换术后早期认知功能的影响[D]. 宁波:宁波大学, 2017. [13] 章放香,宁俊平,邱 冰,等.不同麻醉老年患者术后认知功能障碍发生的比较[J]. 中华麻醉学杂志, 2013,33(2):188-190. [14] Singh P M, Borle A, Mc Gavin J, et al.Comparison of the recovery profile between desflurane and sevoflurane in patients undergoing bariatric surgery-A meta-analysis of randomized controlled trials[J]. Obes Surg, 2017,27(11):3031-3039. [15] 谢思宁, 安立新. 吸入麻醉药的神经毒性作用及其产生机制[J]. 国际麻醉学与复苏杂志, 2015,36(7):631-634.

相似文献/References:

[1]李文波,张文明,白国昌,等.肝硬化患者的人工髋关节置换[J].福建医科大学学报,2017,51(01):44.
 LI Wenbo,ZHANG Wenming,BAI Guochang,et al.Total Hip Arthroplasty in Patients with Liver Cirrhosis[J].Journal of Fujian Medical University,2017,51(04):44.
[2]肖毓华,徐杰.S-ROM假体联合转子下截骨治疗Crowe Ⅳ型髋关节发育不良[J].福建医科大学学报,2017,51(03):175.
 XIAO Yuhua,XU Jie.Application of S-ROM Prosthesis Combined with Subtrochanteric Transverse Osteotomy in Treatment of Crowe Type Ⅳ Developmental Dysplasia of the Hip[J].Journal of Fujian Medical University,2017,51(04):175.

备注/Memo

备注/Memo:
基金项目: 福建省立医院院内优秀青年项目(2014YNQN01)作者简介: 郭 瑜,女,医学硕士 通讯作者: 吴晓丹. Email: wxiaodan@sina.com收稿日期: 2018-06-12
更新日期/Last Update: 2019-10-08