老年非心脏手术患者全身麻醉术后认知功能障碍的发生率及影响因素

目的研究老年非心脏手术患者全身麻醉术后认知功能障碍(POCD)的发生率并了解其影响因素。方法随机选择择期需要全身麻醉且年龄≥65岁的老年非心脏手术患者98例,ASAⅠ~Ⅲ。所有患者在术前、术后24 h、48 h、72 h由同一试验者采用简易智力状态检查法(MMSE)评估患者认知功能。全身麻醉诱导用咪唑安定、乙醚酯、芬太尼、琥珀胆碱,术中麻醉以间断静脉注射维库溴铵,持续静脉注射异丙酚和瑞芬太尼,并间断吸入安氟醚或异氟醚调整麻醉深度。所有患者术后均使用静脉镇痛。结果98例老年患者全身麻醉术后有25例出现POCD,发生率为25.5%。随着年龄增加POCD发生率增加,POCD发病高峰期在术后24h~48 h,高龄、合并高血压和糖尿病、受教育程度偏低更容易引起老年人POCD。结论老年患者全身麻醉术后早期POCD发病率较高,在术中无明显低氧、低血压和术后镇痛效果良好的情况下,高龄、合并高血压和糖尿病、受教育程度偏低是引起老年人POCD的主要危险因素。

Incidence and influential factors of postoperative cognitive dysfunction in old patients with noncardiac surgery after general anesthesia

Objective To investigate the incidence and influential factors of postoperative cognitive dysfunction （POCD） in old patients with noncardiac surgery. Methods 98 patients were selected randomly from patients aged 65 and over, ASA Ⅰ - Ⅲ and underwent noncardiac surgery. The cognitive function of all patients was evaluated by MMSE pre-operation and 24 hour,48 hour,72 hour post-operation by the same researcher. Results 25 from the 98 old patient suffered POCD, and the incidence rate was 25.5%. The POCD peak time was 24 -48 hour post-operation. The rate increased with the age. The older patients, hypertension, diabetes and poor education increased the possibility of POCD. Conclusion The old patients suffered more from POCD after undergoing general anesthesia. Without anoxemia, hypotension per-operation and poor pain management post-operation, the main influential factors may be age, hypertension,diabetes and poor education.