老年患者全麻非心脏手术后短期认知功能障碍29例临床分析

目的探讨老年患者全麻非心脏手术后认知功能障碍（POCD）发病相关因素及防治措施。方法分析发生术后认知功能障碍的29例全麻非心脏手术老年患者（65岁以上），ASA分级Ⅰ～Ⅲ级。年龄（78．4±13．8）岁，65～70岁7例，70～75岁10例，75岁以上12例。体重（58．4±18．2）kg。术前大部分有焦虑情绪，但无POCD。普外科手术4例、泌尿外科手术5例、普胸外科手术9例、骨外科手术8例、妇科手术3例。术前用药为苯巴比妥钠0．1、东莨菪碱0．03mg／kg，全麻诱导采用咪唑安定、异丙酚、芬太尼、维库溴铵；维持采用静吸复合，异丙酚、维库溴铵靶控输注、辅吸异氟醚。结果患者症状出现在术后3d内，21例持续到术后7d，表现为精神错乱、人格改变等。症状以夜间为重。确诊POCD后，立即进行积极治疗。19例给予安定或咪唑安定5～15mg分次静注有效，7例用咪唑安定无效，改用异丙酚静脉持续泵注1～2mg／（kg·h）。其余10例密切观察病情，未行药物治疗。至出院，全组无一例有严重的精神系统后遗症。结论POCD是老年患者术后常见的并发症，围术期必须进行积极的预防和治疗。

Clinical investigation on post operation cognitive dysfunction early after non-cardiac surgery in 29 elderly patients

Objective To investigate the cognitive dysfunction early after non - cardiac surgery in elderly patients and to study the related factors and preventive measures. Methods Twenty - nine patients （ ASA Ⅰ - Ⅲ ） older than 65 years undergoing selective non - cardiac surgery were investigated. All patients were premedicated with luminal O. 1 and scopolamine 0. 03 mg/kg 30 min before surgery. Anethesia was induced with fentanyl 1.0 - 1.5 μg/kg, propofol 1.0 - 2. 0 mg/kg and vecuronium. Anesthesia was maintained with fentanil and propofol intravenous injection continually, and isoflurane inhalation with intermittent intravenous injection of vecuronium. Four patients were subjected to general surgery, 5 to urological surgery, 9 to thoracic surgery, 8 to orthopedics surgery, and 3 to gynecological surgery. Most of the patients suffered anxiety preoperatively. Results All the patients suffered POCD on the post-operative day 3. In 21 patients the symptoms of POCD continued to the 7th day postoperatively, including insomnia, amentia, personality change, etc. The symptoms were severer at night. POCD was treated actively soon after definite diagnosis. Nineteen patients were effectively treated with intermittent intravenous injection of midozolam （5 - 15 mg）, and 7 patients were treated with intravenous injection of propofol continually, because midozolam was ineffective. The remaining 10 patients were not subjected to medication. There were no patients suffering from psychological complications before discharging from hospital. Conclusion POCD is a common complication, and should be prevented and treated actively during operation.