不同麻醉方法对高龄甲状腺瘤患者早期术后认知功能的影响

目的:研究不同麻醉方法对高龄甲状腺瘤患者早期术后认知功能的影响。方法:随机选择60例年龄≥65岁的甲状腺瘤手术老年患者，其中男38例，女22例，分为全身麻醉组（A 组，30例）和颈丛阻滞组（B 组，30例），由同一试验者采用神经心理学测试技术简易智力状态检查（MMSE）两组患者术前1d、术后12h 和术后24h 的认知功能。排除有精神病史或长期服用影响神经系统功能药物的患者。结果:二组术后12h 的MMSE 值低于术前（P<0.05），组间比较差异无统计学意义（P>0.05）；A 组术后12h 和24h POCD的发生率为分别16.7%和3.3%，B 组的术后12h 和24h POCD的发生率为分别10.0%和3.3%（P>0.05）。 结论:与颈丛阻滞相比，全身麻醉不会增加高龄甲状腺瘤患者早期术后认知功能障碍的发生率。 

Influence of Different Anesthesia Methods on the Early Postoperative Cognitive Function in Elder Thyroid Gland Patients

Objective:To study the influence of different anesthesia methods (plexus cervicalis block and general anesthesia) on early postoperative cognitive function in elderly patients who suffer from thyroid disease. Methods:Sixty patients more than 65years old with thyroid disease were randomly given general anesthesia ( Group A,30cases ) and plexus cervicalis block ( Group B, 30cas-es ). The assessment of postoperative cognitive function refers to the scores achieved in the neuropsychological testing using the mini mental state examination ( MMSE ) by the same psychiatrist on the day before the operation and the first 12and 24h after the surgery. Patients with psychosis or neuropathy were excluded, as well as patients who take medicines that affect nervous system function long-term were also excluded. The aggregate MMSE score is 30. The standard deviation of the patient MMSE before the operation was calculated and compared with those of the first 12and 24h after the surgery. Results:The MMSE scores were lower in Groups A and B within the first 12h after surgery than that before the operation ( P < 0.05). The incidence of POCD in Group A within the first 12and 24h after surgery ( 16.7% and 3.3% ) was not statistically different from that in Group B (10.0% and 3.3%;P > 0.05). Conclusion: There is a higher incidence of early POCD after thyroid surgery, especially among patients more than65years old. Compared with the patients who underwent the plexus cervicalis block, the incidence of POCD among the elderly who underwent thyroid surgery under general anesthesia was lower.