Biffoli F, Piacentino V, Meconcelli G, Guidi F, Dal Poggetto L, Bacci I, Peruzzi E
USL 3-Zona Val di Nievole Ospedale di Pescia, Pistoia.
Minerva Anestesiol. 1998 Jan-Feb;64(1-2):13-9.
Influence of anesthetic technique on mental status in elderly patients submitted to major orthopedic procedures of lower limbs. Mental impairment is a common occurrence in elderly patients after major orthopedic surgery. Few studies have been published so far on this topic in spite of its relevant clinical and economic implications.
Controlled, comparative study.
Sixty patients aged > or = 70, ASA I-II, submitted to femoral neck repair.
Anesthesia Dept. and Orthopedic Dept. of a District Hospital in Italy.
The day before surgery the mental status of elected patients was evaluated employing a modified Organic Brain Syndrome (OBS) scale (Gustafsson). The better the mental status, the lesser the OBS score. It was possible therefore to distinguish "oriented" from "confuse" patients (38 vs 22) if they scored < or = 6 or > 6 respectively. Patients from each group were than randomly assigned to receive either GA or selective SA. Neither group was premedicated. GA was induced with propofol 1 mg/kg and maintained with O2/N2O 40/60% and isoflurane; atracurium was employed to facilitate mioresolution. Spinal anesthesia was performed with hyperbaric 1% bupivacaine. All patients were monitored in the Recovery Room (RR) for at least one hour. Occurrence of hypotension and/or hypoxia in the Operating Room (OR) or the RR was immediately treated. Mental status was reassessed on the 1st and 2nd postoperative day and results were compared with the corresponding preoperative OBS scores both in GA patients and in SA patients.
No statistically significant differences were found between pre- and postoperative OBS scores in both GA and SA group, whether "oriented" or "confuse".
Mental status of elderly patients submitted to femoral neck repair doesn't seem to be influenced by the anesthetic technique chosen, independent of preoperative psychic conditions.
麻醉技术对接受下肢大骨科手术老年患者精神状态的影响。精神障碍在老年患者接受大骨科手术后很常见。尽管该问题具有重要的临床和经济意义，但目前关于此主题的研究报道较少。
1）验证麻醉是否在老年患者术后精神错乱中起因果作用；2）比较全身麻醉（GA）和脊髓麻醉（SA）对精神状态的影响。
对照、比较研究。
60例年龄≥70岁、ASA I-II级、接受股骨颈修复手术的患者。
意大利一家地区医院的麻醉科和骨科。
手术前一天，采用改良的器质性脑综合征（OBS）量表（古斯塔夫松）评估入选患者的精神状态。精神状态越好，OBS评分越低。因此，如果患者分别得分≤6分或＞6分，则可以区分“定向良好”和“精神错乱”患者（38例对22例）。然后将每组患者随机分配接受GA或选择性SA。两组均未进行术前用药。GA采用丙泊酚1mg/kg诱导，并用O2/N2O 40/60%和异氟烷维持；使用阿曲库铵促进肌肉松弛。采用1%重比重布比卡因进行脊髓麻醉。所有患者在恢复室（RR）至少监测1小时。手术室（OR）或RR中出现低血压和/或低氧血症立即进行处理。术后第1天和第2天重新评估精神状态，并将结果与GA患者和SA患者相应的术前OBS评分进行比较。
GA组和SA组，无论“定向良好”还是“精神错乱”，术前和术后OBS评分均未发现统计学上的显著差异。
接受股骨颈修复手术的老年患者的精神状态似乎不受所选麻醉技术的影响，与术前精神状况无关。
