摘要
目的 探讨全膝关节置换术后不同镇痛方式下对老年患者早期认知功能障碍（POCD）发生率的影响。方法 选取我院行全膝关节置换术（TKA）的60例老年患者（年龄≥65岁,ASA分级：Ⅰ～Ⅱ级）,根据入院先后顺序随机分为对照组和观察组,每组30例,对照组全膝关节置换术后采用静脉自控镇痛,观察组在对照组基础上辅助连续股神经阻滞镇痛,观察两组患者术后早期认知功能障碍的发生情况。结果 TKA术后,观察组患者的VAS评分、吗啡用量及不良反应的发生率均显著低于对照组（P〈0.05或P〈0.01）;观察组患者术后1d及3d的简易智力状态表（MMSE）评分显著高于对照组,且POCD发生率显著低于对照组,两组差异存在统计学意义（P〈0.05或P〈0.01）。结论 较传统静脉自控镇痛相比,TKA术后连续股神经阻滞镇痛的效果存在明显优势,有助于改善患者的生活质量,值得临床推广。
ObjectiveTo study the clinical effects of different analgesic methods on early postoperativecognitive dysfunction （ POCD ） of senior patients after total knee arthroplasty. Methods 60 cases of patientsaged over 65 years, who received treatment of total knee arthroplasty in our Hospital from June 2013 to June2015 were randomly divided into control group and observation group 30 patients in each group, andreceivedcontrolled intravenous analgesia or continuous femoral nerve block analgesia, respectively. Finally, the incidencesof POCD were recorded in each group. Results On different time points after TKA,patients in observationgroup had lower VAS score,the dosage of morphine and the incidence of adverse reactions than those incontrol group, and the differences between the two groups were statistical significance （ P 〈0.05 or P 〈0.01）.1 d and 3 d after TKA, patients in observation group had higher MMSE score than that in control group, and theincidence of POCD was significantly lower than that in control group,and the differences between the two groupswere statistical significance （ P 〈0.05 or P 〈0.01）. Conclusion Continuous femoral nerve block analgesia appliedto elderly TKA patients for postoperative analgesia has better effects than that of self - control vein analgesia,which can reduce the incidence of early POCD and is benefit to improve the patients＇ life quality.
出处
《湖北科技学院学报（医学版）》
2016年第4期306-308,共3页
Journal of Hubei University of Science and Technology(Medical Sciences)
关键词
全膝关节置换术
认知功能
股神经阻滞
老年
疼痛
Total knee arthroplasty
Femoral nerve block analgesia
Cognitive dysfunction
Pain
Senior patients
