【摘要】 目的 探讨腰硬联合麻醉对老年下肢骨折手术患者认知功能及血清神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平的影响,以期为临床治疗提供参考。方法 选取2022年5月—2024年3月在成都市金牛区人民医院进行手术治疗的92例老年下肢骨折患者为研究对象。采用随机数字表法将患者分为联合组(n=46)和对照组(n=46)。对照组患者给予全身麻醉,联合组患者给予腰硬联合麻醉。比较2组患者手术时间、术中失血量、下床活动时间及不同时间点平均动脉压(MAP)、心率(HR)、简易智力状态量表(MMSE)评分、视觉模拟评分法(VAS)评分与血清NGF、BDNF水平变化情况。结果 2组患者手术时间、术中失血量、下床活动时间比较,差异均无统计学意义(P>0.05)。与麻醉前比较,联合组、对照组患者手术开始时、术毕时MAP、HR均降低,联合组MAP、HR降低幅度均小于对照组,差异均有统计学意义(P<0.05)。与术前比较,2组患者术后24 h、7 d时的MMSE评分均降低,联合组MMSE评分降低幅度小于对照组,差异均有统计学意义(P<0.05)。术前,2组患者血清NGF、BDNF水平比较,差异无统计学意义(P>0.05);与术前比较,联合组、对照组患者术后24 h血清NGF、BDNF水平均明显降低,联合组降低幅度小于对照组,差异均有统计学意义(P<0.05)。联合组患者术后6 h、12 h、24 h的VAS评分均低于对照组,差异有统计学意义(P<0.05)。结论 腰硬联合麻醉在老年下肢骨折患者中展现出良好的应用效果,不仅能降低术后认知功能损伤的发生风险,减轻术后疼痛程度,还有助于维持术中血流动力学的稳定,临床效果显著,值得推广应用。更多还原

【Abstract】 Objective To investigate the effects of combined spinal-epidural anesthesia(CSEA) on cognitive function and serum nerve growth factor(NGF), brain-derived neurotrophic factor(BDNF) levels in elderly patients undergoing lower limb fracture surgery, aiming to provide references for clinical treatment. Methods Ninety-two elderly patients with lower limb fractures undergoing surgery at Chengdu Jinniu District People’s Hospital from May 2022 to March 2024 were selected as the study participants. Patients were assigned to a combined group(n=46) and a control group(n=46) using a random number table. The control group received general anesthesia, while the combined group received CSEA. Operation time, intraoperative blood loss, time to ambulation, mean arterial pressure(MAP), heart rate(HR), Mini-Mental State Examination(MMSE) scores, Visual Analogue Scale(VAS) scores, and serum NGF and BDNF levels at different time points were compared between the two groups. Results No statistically significant differences were observed in operation time, intraoperative blood loss, or time to ambulation between the two groups(P>0.05). Compared with pre-anesthesia, MAP and HR decreased at the beginning of surgery and at the end of surgery in both the combined and control groups; the decreases in MAP and HR were smaller in the combined group than in the control group, with statistically significant differences(P<0.05). Compared with preoperative values, MMSE scores decreased at 24 hours and 7 days postoperatively in both groups; the decrease in MMSE scores was smaller in the combined group than in the control group, with statistically significant differences(P<0.05). Preoperatively, no statistically significant difference was noted in serum NGF or BDNF levels between the two groups(P>0.05); compared with preoperative values, serum NGF and BDNF levels decreased significantly at 24 hours postoperatively in both the combined and control groups, with significantly smaller decreases in the combined group than in the control group(P<0.05). VAS scores at 6 hours, 12 hours, and 24 hours postoperatively were significantly lower in the combined group than in the control group(P<0.05). Conclusion CSEA demonstrates favorable application outcomes in elderly patients with lower limb fractures. It not only reduces the risk of postoperative cognitive impairment and alleviates postoperative pain but also helps maintain intraoperative hemodynamic stability, with marked clinical effects, holding promise for clinical promotion.更多还原