两种麻醉方式对老年病人术后认知功能及应激反应的影响

目的:探讨全身麻醉与硬膜外麻醉对老年病人术后认知功能及应激反应的影响。方法:选取行外科手术治疗的老年病人72例，并按照随机数字表法将其分为2组，每组36例。观察组病人采用硬膜外麻醉方法，而对照组病人采用全身麻醉方法。在手术前后采用简易智力状态检查表（MMES）和韦氏记忆量表（WMS）对老年病人手术前后认知功能的变化情况进行评估。同时，在术前、术后30min和术后6h 3个时间位点测定病人血糖（Glu）和高敏C反应蛋白（hs-CRP）的水平以对病人的应激反应情况进行评估。结果:2组病人术后6 h、24 h和72 h术后认知功能障碍的发生率差异均无统计学意义（P>0.05）。观察组病人术后1 d的MMES得分和WMS各项目（除Memory accumulation和Memory touch）得分均高于术前（P<0.05~P<0.01）；而上述指标在术后3 d的得分与术前相比差异均无统计学意义（P>0.05）。对照组病人术后1 d的MMES得分和WMS各项目（除Memory pictures和Memory touch）得分均高于术前（P<0.01）。观察组病人术后1 d的MMES和Memory experience得分低于对照组（P<0.01），而Memory pictures得分高于对照组（P<0.01）；观察组病人术后3 d的WMS各项目（除Memory accumulation和Memory touch）得分均低于对照组（P<0.05~P<0.01）。观察组病人在术后30 min、6 h机体Glu和hs-CRP的水平均低于对照组（P<0.01）。结论:相对全身麻醉，硬膜外麻醉对病人认知功能及应激反应的负面影响比较小，且用药量少，尤其适用于老年病人，值得临床推广使用。

Effect of the general anesthesia and epidural anesthesia on the postoperative cognitive function and stress response in elderly patients

Objective:To investigate the effects of general anesthesia and epidural anesthesia on the postoperative cognitive function and the stress response in elderly patients.Methods:Seventy-two elderly patients treated with surgery were divided into the observation group and control group according to random number table method(36 cases each group).The observation group and control group were anesthetized using the epidural and general anesthesia,respectively.The cognitive function in two groups before and after operation was assessed using easy mental state examination table(MMES) and Wechsler memory scale(WMS).The levels of glucose(Glu) and high-sensitivity C-reactive protein(hs-CRP) in two groups at preoperative and postoperative 30 min and postoperative 6 h,and stress reaction of patient were analyzed.Results:The differences of the incidence rate of the cognitive disorder between two groups after 6h,24h and 72h of operation were not statistically significant(P>0.05).The scores of MMES and WMS in observation group after operation were higher than those before operation(P<0.05 to P<0.01),and the differences of which between before operation and after 3 d of operation was not statistically significant(P>0.05).The scores of MMES and WMS(except Memory pictures and Memory touch items) in control group after 1 d of operation were significantly higher than those before operation(P<0.01).The scores of MMES and Memory experience of WMS in observation group after 1 d of operation were significantly lower than those in control group(P<0.01),and the score of memory pictures of WMS in observation group after 1 d of operation was higher than that in control group(P<0.01).The scores of WMS(except Memory orientation and Memory touch items) in observation group after 3d of operation were significantly lower than those in control group(P<0.01).The levels of Glu and hs-CRP in observation group after 0.5h and 6 h of operation were significantly lower than those in control group(P<0.01).Conclusions:Compared with general anesthesia,the effect of epidural anesthesia on cognitive function and stress reaction is little,the dose of drug is little.The epidural anesthesia is especially appropriate for elderly patients,and worthy of clinical promotion.