探究椎管内麻醉在老年下肢骨折患者手术治疗中的应用价值。

选取2019年10月至2020年11月成都市双流区第一人民医院收治的102例下肢骨折老年患者为研究对象。依据随机数字表法将入选患者分为椎管内麻醉组和全身麻醉组，各51例。观察两组患者麻醉前后的平均动脉压、血氧饱和度（SpO₂）、心率、认知功能、谵妄症状及术后并发症发生情况。其中，患者认知功能采用简易精神状况检查（mini-mental state examination, MMSE）评价，谵妄症状采用谵妄评定方法（confusion assessment method, CAM）评价。

麻醉前，两组患者血流动力学、认知功能、谵妄症状差异均无统计学意义（P>0.05）。麻醉后，两组患者平均动脉压、心率、SpO₂较麻醉前明显下降（P<0.05），全身麻醉组患者MMSE评分较麻醉前明显下降、CAM评分较麻醉前明显增高（P<0.05），且椎管内麻醉组患者的上述指标均优于全身麻醉组（P<0.05）。椎管内麻醉组患者并发症的发生率明显低于全身麻醉组（7.81%、25.49%；χ²=5.718，P<0.05）。

椎管内麻醉应用于老年下肢骨折手术能有效维持患者的血流动力学稳定，对患者的认知功能及谵妄症状的影响较小，并发症少，值得临床推广。

To investigate the effects of intrathecal anesthesia in elderly patients with lower limb fractures.

102 elderly patients with lower limb fracture admitted to the First People's Hospital of Shuangliu District in Chengdu during October 2019 to November 2020 were enrolled in the study. According to random number table, the patients were divided into intrathecal anesthesia group and general anesthesia group with 51 patients in each group. The mean arterial pressure (MAP), blood oxygen saturation (SpO₂), heart rate, cognitive function, delirium symptoms and postoperative complications were observed in both groups. Patients' cognitive function was evaluated by mini-mental state examination (MMSE), and delirium symptoms were evaluated by confusion assessment method (CAM).

There was no significant difference in hemodynamics, cognitive function and delirium symptoms between the two groups before anesthesia (P > 0.05). After anesthesia, the MAP, heart rate and SpO2 in the two groups were significantly lower than those before anesthesia (P < 0.05). The MMSE score in the general anesthesia group was significantly lower than that before anesthesia, and the CAM score was significantly higher than that before anesthesia (P < 0.05). All of the above indexes of patients in intrathecal anesthesia group were better than those in general anesthesia group after anesthesia (P < 0.05). The total incidence of complications in intrathecal anesthesia group was 7.84%, which was significantly lower than that in general anesthesia group (25.49%) (χ²=5.718, P < 0.05).

Intrathecal anesthesia can effectively stabilize the hemodynamics of elderly patients with lower limb fracture, with less cognitive decline, delirium symptoms and complications, which is worthy of clinical promotion.