小剂量吗啡伍用局麻药行椎管内麻醉对老年患者术后认知功能影响的观察

Treatment effects of intrathecal anesthesia combined small dose morphine on postoperative cognitive function in elderly patients

目的：评价小剂量吗啡伍用利多卡因用于硬膜外麻醉对老年患者术后认知功能的影响。方法：240例66岁以上择期手术患者分为3组，分别行全身麻醉、单纯硬膜外麻醉及脊—硬联合阻滞麻醉。单纯硬膜外麻醉组（观察组）予吗啡3mg和2%利多卡因混合液，手术开始前静脉输注咪达唑仑0.05mg/kg。麻醉前1天及术后24、48和72h用MMS测试方法评定患者的认知功能。结果：观察组患者术后POCD发生率低于其他两组；术后24-72h，3组间MMS评分比较存在明显差异（P〈0.05）。结论：观察组麻醉方法属于神经阻滞和受体结合的麻醉方法，可产生完善的镇痛与镇静效果，使镇痛-镇静达到峰值平衡，且其对老年患者血流动力学和心脑等脏器氧供及氧耗的关系没有明显影响，是预防老年患者术后POCD的有效麻醉方法。

Objective： To evaluate the effects of general anesthesia and intrathecal anesthesia on postoperative cognitive function in the elderly. Methods：120 patients aged ≥ 66 years old undergoing general anesthesia or intrathecal anesthesia were divided into three groups averagely. All patients were given with penehyclidine. The Mini-Mental State（ MMS） test was used to assess cognitive function 1 d before operation and 12 h,24 h and 72 h of post operation. Results：There were on significant defferences in MMS scores between the two groups 1 d before operation and 72 h after operation. At 72 h after operation the percentage of the patients with cognitive dysfunction decreased to 10% in general anesthesia group and none in intrathecal anesthesia group. Conclusions： Intrathecal anesthesia is associated with a faster early recovery after operation than general anesthesia in the elderly patients.