全身麻醉与硬膜外麻醉对老年骨科手术患者短期认知功能的影响

目的观察不同麻醉方式对老年骨科患者术后短期认知功能的影响。方法 102例老年骨科患者随机分为全身麻醉组和硬膜外麻醉组,每组51例,分别采用全身麻醉和硬膜外麻醉,观察2组患者手术过程中的平均动脉压(MAP)、动脉血氧饱和度(SpO2)、心率(HR)、手术时间、出血量和液体出入量,并分别于手术前1 d、手术后12 h及1、7 d进行简易精神状态检查(MMSE)评价,比较2组麻醉患者手术前后MMSE评分变化及术后认知功能障碍(POCD)发生率。结果 2组患者手术均成功,全身麻醉组和硬膜外麻醉组患者的MAP、HR、SpO2、手术时间、麻醉时间、出血量及液体出入量比较差异均无统计学意义(P>0.05)。手术前全身麻醉组患者MMSE评分与硬膜外麻醉组比较差异无统计学意义(P>0.05);手术后12 h及1、7 d,全身麻醉组患者和硬膜外麻醉组患者的MMSE评分均逐渐升高(P<0.05),但均低于手术前(P<0.05);手术后同一时间,全身麻醉组的MMSE评分均低于硬膜外麻醉组(P<0.05)。手术后12 h及1、7 d,全身麻醉组和硬膜外麻醉组患者的POCD发生率均逐渐降低(P<0.05);同一时间点硬膜外麻醉组患者POCD发生率低于全身麻醉组(P<0.05)。结论全身麻醉和硬膜外麻醉均可导致老年骨科患者POCD发生,而全身麻醉对患者认知能力的影响大于硬膜外麻醉,发生POCD的可能性更大。

Effect of general and epidural anesthesia on cognitive function in elderly patients with short-term operation in department of orthopedics

Objective To observe the effect of different methods of anesthesia on cognitive function in elderly patients with short-term postoperative in department of orthopedics. Methods A total of 102 cases of elderly patients in department of orthopedics were randomly divided into epidural anesthesia group and general anesthesia group with 51 cases in each group,which were given general anesthesia and epidural anesthesia respectively. The mean arterial pressure（ MAP）,pulse oxygen saturation（ SpO2）,heart rate（ HR）,operation time,bleeding volume and fluid intake and liquid discharge during the operation were observed in the two groups,and mini mental state examination（ MMSE） was made at 1 d before operation,12 h,1 d and 7 d after operation. The changes of MMSE score before and after the operation and postoperative cognitive dysfunction（ POCD） incidence were compared between the two groups. Results All the operation of patients in the two groups was successful. There was no significant difference of MAP,HR,SpO2,operation time,anesthesia time,amount of bleeding,fluid intake and output between general group and epidural group. The MMSE score in general group before operation had no significant difference compared with that in epidural anesthesia group（ P〉0. 05）. At 12 h,1 d and 7 d after operation,the MMSE scores in the two groups were increased gradually（ P〈0. 05）,but they were significantly lower than those before operation（ P〈0. 05）; At the same time after operation,MMSE scores of general anesthesia group were lower than those in the epidural anesthesia group（ P〈0. 05）. At 12 h,1 d and 7 d after operation,the incidence of POCD in the two groups decreased gradually（ P〈0. 05）,which was significantly lower in the epidural anesthesia group than that in the general anesthesia group（ P〈0. 05）. Conclusion General anesthesia and epidural anesthesia can lead to POCD in elderly patients in the department of orthopedics,but general anesthesia has much more influence on patients?