青年患者小手术后近期认知功能的变化

目的 探明青年患者小手术后近期认知功能的变化.方法 择期行脐部以下部位小手术(手术时间＜2 h)青年患者(18岁～39岁)60例,ASA Ⅰ～Ⅱ级,采用完全随机设计法分为全凭静脉麻醉组与硬膜外麻醉组各30例,对照组为青年健康志愿者30例.分别于术前1 d,术后3 d行6项认知功能测定.结果 完成全程测验60例,其中对照组21例,全麻组18例,硬膜外组21例.术后各项测验值普遍高于术前测验值(P＜0.05).全麻组和硬膜外组多项测验数值在术前和术后低于对照组(P＜0.05).按Z计分诊断术后第3天认知功能障碍(postoperative cognitive dysfunction,POCD)发生5例,其中对照组1例,全麻组3例,硬膜外组1例.组间差异无统计学意义(x2=2.338,P=0.31).结论 小手术青年患者在术前注意力已有所下降,术后注意力、记忆力和思维能力都有一定程度的受损.全身麻醉和硬膜外麻醉后近期各项认知功能的变化及POCD的发生率差异无统计学意义.

Short-term postoperative cognitive function change in young patients undergoing minor surgery

Objective To investigate the short-term postoperative cognitive function change in young patients undergoing minor surgery. Methods 60 young patients ( 18 y-39 y old) scheduled for minor surgery (operation time ＜2 h, below the level of umbilicus) were recruited and classified randomly into two groups: general anesthesia group and epidural anesthesia group, and control group were composed of 30 young healthy volunteers. A set of six neuropsychological tests from the Wechsler Adult Intelligence Scale was administered on two occasions: 1st day before operation (baseline) and 3rd day after operation. Results 60 objects had finished all the tests, 21 cases in control group, 18 cases in general anesthesia group and 21 cases in epidural group.Most of test scores after operation were significantly higher than test scores before operation (P＜0.05). Some of test scores before and after operation in both general anesthesia group and epidural anesthesia group were significantly lower than that of control group (P＜0.05 )respectively. According to Z score definition, there were total 5 cases diagnosed as postoperative cognitive dysfunction(POCD).Among the 5 cases, there was 1 case in control group, 3 cases in general anesthesia group and 1 case in epidural anesthesia group.The differences among groups showed no statistical significance(x2=2.338,P=0.31 ). Conclusion Impairment of cognitive function of surgical patients has occurred not only postoperatively but also preoperatively. According to the results of six neuropsychological tests and the incidence of POCD, there is no significant differences between general anesthesia and epidural anesthesia.