曲宁;
QU Ning;Department of Anesthesiology,Qinghai Provincial Hospital of Traditional Chinese Medicine;

• 1:青海省中医院麻醉科

摘要(Abstract)：

目的:探讨硬膜外联合全身麻醉对老年骨科手术患者术后认知功能和炎症介质的影响。方法:79例行股骨头置换手术患者分为观察组(硬膜外联合全身麻醉,n=41)和对照组(全身麻醉,n=38),两组患者于术后12、24、48及72 h采用简易智力状态检查量表(MMSE)评价两组患者的认知功能;并于术后24 h抽取空腹静脉血,采用酶联免疫吸附试验(ELISA)检测血清白细胞介素-6(IL-6)和淀粉样蛋白1-40(Aβ1-40)含量,采用胶体金法测定C反应蛋白(CRP)和D-二聚体(D-D)含量,采用Pearson分析IL-6、Aβ1-40、D-D与MMSE评分的相关性。结果:术后12 h和24 h,观察组患者MMSE评分明显均高于对照组(P<0.05);术后48、72h时,两组患者MMSE评分比较,差异无统计学意义(P>0.05);术后24 h,观察组患者血清IL-6、Aβ1-40及D-D水平明显低于对照组(P<0.05),而两组血清CRP水平比较差异无统计学意义(P>0.05);观察组患者术后24 h血清IL-6、Aβ1-40及D-D与MMSE评分均呈现负相关关系(r=-0.415、-0.664、-0.369,P<0.05)。结论:硬膜外联合全身麻醉可能通过降低老年股骨头置换术患者血清中IL-6、Aβ1-40及D-D水平减少术后认知功能障碍的发生。
Objective:To investigate the effect of epidural anesthesia combined with general anesthesia on postoperative cognitive function and inflammatory mediators in elderly patients undergoing operation in department of orthopedics.Methods:79 cases of femoral head replacement surgery patients were divided into observation group of 41 cases with epidural anesthesia combined with general anesthesia and control group of 38 cases with general anesthesia.MMSE score detecting cognitive function and serum levels of IL-6,Aβ1-40,CRP and D-dimer(D-D) were compared between the two groups.The relationship of IL-6,Aβ1-40,CRP and D-D with MMSE score was detected.Results:MMSE scores in 12 h,24 h after operation in observation group were significantly higher than the control group(P<0.05),MMSE scores in 48 h,72 h after operation in two groups had no significant difference(P>0.05);The levels of IL-6,Aβ1-40 and D-D in observation group 24 h after operation were significantly lower than those of the control group(P<0.05),but there was no significant difference in CRP levels between the two groups(P>0.05);The levels of IL-6,Aβ1-40 and D-D were negatively correlated with MMSE scores(r=-0.415、-0.664、-0.369,P<0.05).Conclusions:Epidural anesthesia combined with general anesthesia may reduce the incidence of POCD through reducing IL-6,Aβ1-40 and D-D levels in patients undergoing femoral head replacement surgery.

关键词(KeyWords)： 股骨头置换术;硬膜外麻醉;全身麻醉;认知功能;机制
femoral head replacement;epidural anesthesia;general anesthesia;cognitive function;mechanism

Abstract:

Keywords:

基金项目(Foundation): 青海省应用基础研究项目(2014-ZJ-730)

作者(Author): 曲宁;
QU Ning;Department of Anesthesiology,Qinghai Provincial Hospital of Traditional Chinese Medicine;

Email:

DOI: 10.19367/j.cnki.1000-2707.2016.12.022

参考文献(References)：

• [1]王可安.对比全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的影响分析[J].中国伤残医学,2015(22):180-181.
• [2]Berger M,Nadler JW,Browndyke J,et al.Postoperative cognitive dysfunction:minding the gaps in our knowledge of a common postoperative complication in the elderly[J].Anesthesiol Clin,2015(3):517-550.
• [3]赵景祥.不同麻醉方法对老年骨科手术患者术后短期认知功能及安全性的影响[J].河南外科学杂志,2014(6):61-63.
• [4]Yap KK,Joyner P.Post-operative cognitive dysfunction after knee arthroplasty:a diagnostic dilemma[J].Oxf Med Case Reports,2014(3):60-62.
• [5]王荣国,田守进.全麻联合硬膜外麻醉对老年患者股骨头置换术后近期认知功能障碍的影响[J].中国煤炭工业医学杂志,2015(12):1996-1999.
• [6]潘秋宁,宣懂,林智.老年骨科患者术后精神障碍影响因素分析[J].现代医药卫生,2014(12):1781-1782.
• [7]黄春艳,王洪阳,李阳波,等.两种麻醉方式对老年高血压患者术后早期认知功能的影响[J].环球中医药,2015(S2):18-19.
• [8]毕斌,何军,罗洁,等.血清IL-6、IL-18及TNF-α水平对抑郁症首次发作的诊断价值[J].贵州医科大学学报,2016(5):546-550.
• [9]苏晗,张洁.两种不同麻醉方式对老年骨科患者术后短期认知功能的影响比较研究[J].中华全科医学,2013(9):1354-1354.
• [10]马华山,刘金山,田玲,等.高龄全膝关节置换中全麻和硬膜外麻醉对凝血功能的影响[J].中国组织工程研究,2015(35):5610-5614.

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