硬膜外麻醉与全身麻醉对老年患者术后认知功能的影响

目的研究探讨硬膜外麻醉与全身麻醉对老年患者术后认知功能影响的临床意义。方法随机选取美国麻醉医师协会Ⅰ～Ⅱ级、无严重心脑血管疾病、无重大呼吸循环系统疾病、未服用影响神经精神系统功能的药物且行择期骨科大手术的老年(≥65岁)患者150例,按所采用的麻醉方法的不同将患者分为硬膜外麻醉组(硬膜外组)和全身麻醉组(全麻组)。记录不同时间点的平均动脉压(BP)和心率(HR),采用简易智力状态检查(MMSE)法测定两组患者不同时间点的认知功能,最大评分为30分,≤23分即可认为发生了认知功能障碍(POCD)。结果两组患者在麻醉前、麻醉后手术前、手术30min时、主要手术步骤操作时、手术结束时的BP与HR比较差异无统计学意义(P>0.05);在麻醉后的24h,硬膜外组MMSE评分明显高于全麻组(P<0.05),其余时间点差异无统计学意义(P>0.05)。POCD发生率在麻醉后6h和12h硬膜外组发生率低于全麻组,分别为13.3%与6.7%、24.0%与20.0%,差异有统计学意义(均P<0.05)。结论在硬膜外麻醉与全身麻醉中,老年患者术后早期均可发生POCD,而全身麻醉在术后24h内对老年患者认知功能的影响比硬膜外麻醉更为明显。

The effect of epidural anesthesia and general anesthesia on postoperative cognitive function in elderly patients

Objective To study the clinical significance of epidural anesthesia and general anesthesia on postoperative cognitive function in elderly patients.Methods Randomly selected 150 elderly（≥65 years） patients,who were in accordance with the ASA I-Ⅱ grade,non-serious cardiovascular and cerebrovascular diseases,no significant respiratory and circulatory system diseases,neuropsychiatric system function without taking affect drug elective major orthopedic surgery,according to the different anesthesia methods,patients were averagely divided into epidural anesthesia（epidural group） and general anesthesia（general anesthesia group）.Mean arterial blood pressure（BP） and heart rate（HR） were recorded at different points,using the Mini-Mental State Examination（MMSE） to determine the cognitive functions of the two groups patients at different time,the maximum score was 30 points,and the score less than 23 points could be considered the cognitive dysfunction（POCD）.Results The arterial BP and HR of the two groups patients before anesthesia,after anesthesia before surgery,surgery 30 min,the main surgical steps and the end of surgery,were no significant difference（P〈0.05）;Anesthesia after 24 h,the epidural group MMSE score was significantly higher than the general anesthesia group（P〈0.05）,and no statistically significant difference in the rest of the time（P〈0.05）.The incidence of cognitive dysfunction after anesthesia 6 h and 12 h of the epidural group were 13.3% and 6.7%,which was lower than the general anesthesia group included 24.0% and 20.0%,the difference were statistically significant（P〈0.05）.Conclusion Elderly patients in early postoperative epidural anesthesia and general anesthesia both can suffer POCD,while general anesthesia is more obvious in the postoperative effect of 24 h on the cognitive function in elderly patients than epidural anesthesia.