不同麻醉方法对老年患者术后早期认知功能影响的研究

目的通过简易智能状态检查法（MMSE）行神经心理学的测试和采用Newman的方法，研究不同麻醉方法对老年患者术后早期认知功能的影响。方法选择无明显呼吸、循环系统疾病，排除有精神神经系统疾病史或服用相应药物老年患者150例，随机分硬膜外组和全麻组，硬膜外组又随机分为硬膜外麻醉、腰-硬膜外麻醉两亚组；全麻组随机分为全身麻醉、全身-硬膜外复合麻醉、全身-腰硬膜外复合麻醉三亚组，每组30例。记录患者麻醉前、术后6h、6d的MMSE评分、术后认知功能障碍的发生率。结果所有组MMSE评分在术后6h与麻醉前比较差异有统计学意义（P〈0．05）．全麻和硬膜外麻醉组比较差异有统计学意义（尸〈0．05），硬膜外组中各亚组比较无统计学无差异（P〉0．05），全麻纽中各亚组比较无统计学差异（P〉0．05）。术后6h全麻组和硬膜外组POCD发生率两组比较差异有统计学意义（P〈0．05），硬膜外组中各亚组比较无统计学无差异（P〉0．05）．全麻组中各亚组比较无统计学差异（P〉0．05）。全麻和硬膜外组及其各亚组术后6d的MMSE评分和术前无差别．POCD发生率无差别（P〉0．05）。结论老年患者硬外麻和全麻术后早期都可发生POCD，全麻患者较硬外麻患者术后6h的POCD发生率高和MMSE评分低，木后6d不同的麻醉方法对POCD发生的影响和MMSE评分无明显差异。

Study on the Influence of Different Anesthesiasenile Methods to Senile Patients about Early Postoperative Cognition

Objective To investigate the influence of different anesthesiasenile methods to senile patient about early postoperative cognition by m/hi-mental state examimation（MMSE） to test neuropsychology and by Newman way. Methods The 150 senile patients without the disease of respiration and circulatory, without psycho-nervous system disease or taking the corresponding drug, were divided into the epidural group and general anesthesia group. The cases in epidural group were divided into the epidural anesthesia group and waist-pidural anesthesia group, and the cases in general anesthesia group were divided into the general anesthesia group, general-epidural group and general-waist-pidural anesthesia group, with 30 cases in every group. The scores of mini-mental state examimation and rate of cognition dysfunction before anesthesiasenile, 6 hours after operation, 6 days after operation were recorded. Results There was significant difference on scores of mini-mental state examimation before anesthesiasenile and 6 hours after operation （P〈0.05）. There was significant difference on scores of mini-mental state examimation between the epidural group and general anesthesia group （P〈0.05）, and there was no significant difference on scores of mini-mental state examimation between subsection of the epidural group （P 〉0.05）. There was no significant difference on scores of mini-mental state examimation between subsection of general anesthesia group （P 〉0.05）. There was significant difference on rate of POCD between the epidural group and general anesthesia group 6 hours after operation （P〈0.05）, and there was no significant difference on rate of POCD between subsection of the epidural group （P〉0.05）, there was no significant difference on rate of POCD between subsection of general anesthesia group （P 〉0.05）.There was no significant difference on scores of mini-mental state examimation and rate of POCD on 6 hours after operation between the epidural group and general anesthesia group （P 〉0.05）. Conclusion POCD can happen early in senile patients of epidural group and general anesthesia group after operaion. The incidence of POCD is higher and the scores of mini-mental state examirnation are lower in general anesthesia group than those in epidural group in 6 hours after operation. Different anesthesia methods have no significant difference on the incidence of POCD and the MMSE scores in 6 days after operation.