腰硬联合麻醉与全麻对老年腹部手术患者术后短期认知功能的影响

目的 探讨腰硬联合麻醉(CSEA)与全麻对老年腹部手术患者术后认知功能的影响。方法 选取本院2018年5月—2019年5月收治的82例老年腹部手术患者,按随机数表法分为观察组和对照组,各41例。观察组应用CSEA,对照组则采用全身麻醉。比较两组的麻醉相关指标,术后6 h、12 h、24 h的精神功能状态以及患者术后短期认知功能障碍的发生率。结果 观察组麻醉起效时间(min)、完全清醒时间(min)分别为(8.19±1.04)、(28.67±5.60)与对照组的(10.17±2.12)、(37.25±6.12)比较差异有统计学意义(P<0.05);观察组视觉模拟评分(VAS)(3.51±1.12)与对照组的(4.27±1.15)比较差异有统计学意义(P<0.05);观察组患者术后6 h、12 h、24 h时的MMSE评分分别为(22.27±1.46)、(26.23±1.26)、(28.19±1.24),均高于对照组的(21.46±1.35)、(24.68±1.23)、(26.37±1.19)(P<0.05);观察组短期内POCD的发生率为4.88%,低于对照组的24.39%,差异有统计学意义(P<0.05)。结论 对老年腹部手术患者采用CSEA,不仅能缩短麻醉起效时间和完全清醒的时间,减轻疼痛,而且对患者精神功能的影响小,可有效减少短期内认知功能障碍发生率。

Effect of combined spinal epidural anesthesia and general anesthesia on postoperative short-term cognitive function in elderly patients undergoing abdominal surgery

Objective To investigate the effect of combined spinal epidural anesthesia (CSEA) and general anesthesia on postoperative cognitive function in elderly patients undergoing abdominal surgery. Methods A total of 82 elderly patients with abdominal surgery in our hospital from May 2018 to May 2019 were randomly divided into an observation group and a control group with 41 cases in each group. The observation group was given CSEA, while the control group was given general anesthesia. The anesthesia related indexes, mental function status at 6 h, 12 h and 24 h after operation and the incidence of short-term cognitive dysfunction were investigated and compared between the two groups. Results The onset time of anesthesia (min) and complete awake time (min) in the observation group were (8.19±1.04) and (28.67±5.60) respectively, which were significantly different from those in the control group: (10.17±2.12) and (37.25±6.12) (P<0.05); the visual analogue scale (VAS) was (3.51±1.12) in the observation group, which was significantly different from that in the control group: (4.27±1.15) (P<0.05). The mini-mental state examination (MMSE) scores at 6 h, 12 h and 24 h in the observation group were (22.27±1.46), (26.23±1.26), and (28.19±1.24), which were significantly higher than those in the control group: (21.46±1.35), (24.68±1.23), and (26.37±1.19) respectively (P<0.05); the incidence of postoperative cognitive dysfunction (POCD) in the observation group was 4.88%, significantly lower than that in the control group (24.39%, P<0.05). Conclusion CSEA for elderly patients with abdominal surgery can not only shorten the onset time of anesthesia and fully awake time, reduce pain, but also have little impact on the mental function of patients, which can effectively reduce the incidence of cognitive dysfunction in the short term.