右美托咪定辅助下不同阻滞方式对老年人股骨头置换术后认知功能的影响

目的探讨右美托咪定辅助下腰硬联合麻醉和全身麻醉对老年人股骨头置换术后认知功能的影响。方法选取2017年8月至2019年10月本院收治的拟行人工股骨头置换术的86例股骨头坏死患者为研究对象,采用随机数表法分为对照组和观察组,各43例。对照组行全身麻醉,观察组行腰硬联合麻醉并全程辅以右美托咪定。比较两组认知功能、POCD发生率、血清学指标(S-100β、NSE、CRP、TNF-α、IL-6)水平。结果术前,两组MoCA评分比较差异无统计学意义;术后1、2、48、72 h,观察组MoCA评分均明显高于对照组(P<0.05)。观察组POCD发生率为4.65%,显著低于对照组的16.27%(P<0.05)。术前,两组血清S-100β、NSE、CRP、TNF-α、IL-6水平比较差异无统计学意义;术后,观察组S-100β、NSE、CRP、TNF-α、IL-6水平均明显低于对照组(P<0.05)。结论右美托咪定辅助腰硬联合麻醉能提高老年股骨头置换术后患者的认知功能,降低术后认知功能障碍的发生率。

The effect of different block methods with the aid of dexmedetomidine on the cognitive function of the elderly after femoral head replacement

Objective To investigate the effect of dexmedetomidine-assisted combined spinal-epidural anesthesia and general anesthesia on the cognitive function of the elderly after femoral head replacement.Methods 86 patients with osteonecrosis of the femoral head who were admitted to our hospital from August 2017 to October 2019 who were planned to undergo artificial femoral head replacement were selected as the research subjects.They were divided into control group and observation group by random number table method,with 43 cases in each group.The control group underwent general anesthesia,and the observation group underwent combined spinal-epidural anesthesia and supplemented with dexmedetomidine.The cognitive function,the incidence of POCD,and the levels of serological indicators(S-100β,NSE,CRP,TNF-α,IL-6)were compared between the two groups.Results Before surgery,there was no significant difference in MoCA scores between the two groups.At 1 h,2 h,48 h,and 72 h after surgery,the MoCA scores of the observation group were significantly higher than those of the control group(P<0.05).The incidence of POCD in the observation group was 4.65%,it was significantly lower than the 16.27%of the control group(P<0.05).Before surgery,there was no significant difference in the levels of serum S-100β,NSE,CRP,TNF-α,and IL-6 between the two groups;after surgery,the levels of S-100β,NSE,CRP,TNF-α,and IL-6 in the observation group,which were significantly lower than the control group(P<0.05).Conclusion Dexmedetomidine-assisted combined spinal-epidural anesthesia can improve the cognitive function of elderly patients after femoral head replacement and reduce the incidence of postoperative cognitive dysfunction.