硬膜外阻滞对老年全身麻醉下腹腔镜结肠癌根治术后认知功能的影响

目的：观察全身麻醉联合硬膜外阻滞对老年患者腹腔镜结肠癌根治术后认知功能（POCD ）的影响。方法选择2011年6月至2014年3月该院行腹腔镜结肠癌根治术的老年患者60例，患者分为常规全身麻醉组（对照组）和硬膜外阻滞复合全身麻醉组（观察组），每组30例。简易精神状态量表（MMSE）评价认知功能，ELISA法检测患者外周血S‐100β蛋白表达水平。结果两组麻醉后自主呼吸恢复时间、苏醒时间、拔管时间及麻醉中瑞芬太尼用量差异无统计学意义（P＞0．05），观察组麻醉中丙泊酚用量和麻醉后恶心呕吐发生率均显著低于对照组（P＜0．05）。术后1、3 d MMSE评分两组均出现显著的减低（P＜0．05），观察组均显著高于对照组（P＜0．05）。术后1、3 d对照组认知功能障碍（POCD）发生率为36．7％和23．3％，均显著高于观察组的20．0％和13．3％（ P＜0．05）。术后1、3 d S‐100β蛋白表达水平两组均出现显著的升高（ P＜0．05），观察组均显著低于对照组（ P＜0．05）。结论全麻联合硬膜外阻滞对腹腔镜下结肠癌根治术老年患者认知功能影响小，可显著降低POCD发生，具有一定的临床应用价值。

The effect of general anesthesia combined with epidural anesthesia on postoperative cognitive function in elderly colon cancer patient underwent laparoscopic radical operation

Objective To observe the effect of general anesthesia combined with epidural anesthesia on postoperative cogni‐tive dysfunction(POCD) in elderly colon cancer patient underwent laparoscopic radical operation .Methods 60 cases of elderly pa‐tients underwent laparoscopic radical colon cancer operation were sellected in Qionghai People′s Hospital of Hainan Province .The patients were divided into :general anesthesia control group(n=30)and general anesthesia combined with epidural anesthesia obser‐vation group (n=30) .The cognitive function was estimated by MMSE .The expression of S‐100βprotein was determined by ELISA analysis .Results The recovery time of respiratory depression ,drowsiness and extubation and remifentanil dosage was no no signifi‐cant differences between the two groups(P>0 .05) .The propofol dosage and rate of nausea and vomitting was lower in observation group than that in control group(P< 0 .05) .Before anesthesia ,the MMSE value was no significant difference between the two groups(P>0 .05) .MMSE value was decrease after operation for 1 and 3 d(P<0 .05) .However ,MMSE value was higher in obser‐vation group than that in control group (P<0 .05) .The rate of POCD in control group was 36 .7% and 23 .3% after operation for 1 and 3 d ,which was higher than that of 20 .0% and 13 .3% in observation group(P<0 .05) .Before anesthesia ,the S‐100βexpres‐sion was no significant difference between the two groups(P>0 .05) .The S‐100βexpression was increase after operation for 1 and 3 d(P<0 .05) .However ,the S‐100βexpression was lower in observation group than that in control group (P<0 .05) .Conclusion The general anesthesia combined with epidural anesthesia can decrease POCD in elderly colon cancer patient underwent laparoscopic radical operation ,with worthy of clinical application .