全麻合并硬膜外麻醉对老年术后认知功能障碍的影响

Effect of general anesthesia and epidural anesthesia combination on postoperative cognitive dysfunction in elder

目的：探讨全麻复合硬膜外麻醉对老年患者术后认知功能障碍（POCD）的影响及血浆炎症因子与POCD的关系.方法：60例ASAⅠ-Ⅲ级,择期行上腹部手术患者,随机均分为两组：异氟醚全麻组（30例,G组）,与异氟醚全麻合并硬膜外麻醉组（30例,C组）.分别于术前24 h,术后6、24、48、96 h,采用简化智能评分（MMSE）评估认知功能;在相应时点抽取静脉血,离心提取血清,采用免疫酶联吸附法（ELISA）检测TNF-α.结果：两组患者术前MMSE评分、TNF-α蛋白测定值差异无统计学意义.与术前基础值比较,两组患者术后6、24、72 h MMSE评分均有明显下降（P〈0.05）.两组间MMSE评分比较,术后6、24 h时点G组较C组差异有统计学意义（P〈0.05）.术后各时间点血清TNF-α浓度G组均较复合麻醉组高（P〈0.05）.结论：吸入全麻联合硬膜外麻醉可显著降低老年患者上腹部手术POCD发生率.

Objective： To study the effects of general anesthesia combined with epidural anesthesia on postoperative cognitive dysfunction （POCD） in the elder,and to study the correlation between plasma inflammatory factor and POCD. Methods： Sixty patients, scheduled for upper abdominal surgery with ASA Ⅰ - Ⅲ, were equally and randomly divided into Forane general anesthesia group （ group G, n = 30） and Forane general anesthesia combined with epidural anesthesia group （ group C, n = 30 ）. Mini-mental state examination （ MMSE ） was used to evaluate cognitive function 24 h before operation, and 6,24,48 and 96 after operation. Venous blood at corresponding time was extracted, and then serum was gained by eentrifugation. ELISA was used to detect TNF-α. Results：No significant difference was found in preoperative MMSE score and TNF-α protein value in both groups. Comparing with preoperative basic value, MMSE scores at postoperative 6,24 and 72 h all decreased significantly in both groups （P 〈 0.05 ）. MMSE score comparison between both groups showed significant difference at postoperative 6 and 24 h（ P 〈 0.05 ）. Concentrations of serum TNF-α at each postoperative time points in G group were significantly higher than those of group C （ P 〈 0. 05 ）. Conclusion： General anesthesia combined with epidural anesthesia during upper abdominal surgery may significantly decrease incidence of POCD in elder.