七氟醚吸入全麻和椎管内麻醉对老年泌尿外科手术患者认知功能的影响

目的：探讨七氟醚吸入全麻和椎管内麻醉对老年泌尿外科手术患者认知功能的影响。方法研究68例择期泌尿手术的老年患者随机均分为七氟醚吸入全麻组（A组）和椎管内麻醉组（B组），分别记录两组麻醉时间、手术出血量、术中输液量、低血压和低氧血症发生次数，同时采用简易精神状况检查量表（MMSE）评估两组患者麻醉前1d及术后1d、3d、7d的认知功能。结果两组麻醉时间、手术出血量、术中输液量、低血压和低氧血症发生次数比较差异无统计学意义（P〈0.05）。两组术后1d、3d的MMSE评分均明显低于手术前，且A组显著低于B组，差异均具有统计学意义（P〈0.05）；A组术后7 d的MMSE评分显著低于手术前，但与对照组比较差异无统计学意义（P〈0.05）；A组术后1d及3d的POCD发生率均明显高于B组，具有统计学意义（P〈0.05），而两组术后7d 的POCD发生率差异无统计学意义（P〈0.05）。结论七氟醚吸入全麻较椎管内麻醉对老年泌尿外科手术患者更易发生认知功能障碍。

The effects of sevoflurane inhalation anesthesia and spinal canal anesthe-sia on cognitive function in patients with urinary surgery in the elderly

Objective To observe the effects of sevoflurane inhalation anesthesia and spinal canal anesthesia on cogni-tive function in patients with urinary surgery in the elderly. Methods Researched 68 patients that undergoing elective urinary surgery in elderly patients, and then randomly divided into the sevoflurane inhalation anesthesia group （group A） and spinal canal anesthesia group （group B）. The two groups were recorded time of anesthesia operation, surgical blood loss and transfusion volume, low blood pressure and the number of hypoxemia occurred, at last used the simple mental state examination （MMSE） to evaluate two groups of patients with 1 d before anesthesia and postoperative 1 d, 3 d, 7 d cognitive function. Results Two groups of anesthesia operation in time, surgical blood loss and transfusion volume, low blood pressure and the number of hypoxemia occurred had no significant differences（P〉0.05）. Two groups of postoper-ative 1 d, 3 d MMSE score were significantly lower than before operation, and the group A was significantly lower than group B, the differences were statistically significant（P 〈0.05）;MMSE of A group ofter treatment for 7days were signifi-cantly lower than before the operation, but there was no significant difference compared with controls of groupA ofter treatment for 7 days （P〉0.05）; The incidence of POCD postoperative 1 d and 3 d in groupA were significantly higher than that of group B, with significant difference （P〈0.05）, and the incidence of POCD difference of two groups of post-operative 7 d was not significant （P 〉0.05）. Conclusion Sevoflurane inhalation anesthesia is spinal canal anesthesia cognitive dysfunction occurred more often in patients with elderly urinary surgery.