不同量表评估全麻后老年病人早期认知功能意义的比较

Comparison of early postoperative cognitive function evaluated with different neurocognitive test batteries in elderly patients

目的探讨老年病人行全麻下非心脏手术后早期认知功能的评估策略并比较全凭静脉和静吸复合麻醉对术后早期认知功能的影响。方法选择全麻下行择期非心脏手术且年龄≥65岁的老年病人142例,全麻方式为全凭静脉与静吸复合麻醉,选用包括简易智力量表(MMSE)、数字广度测验、数字符号测验、循迹连线测验和理解记忆等5项测验的一系列神经心理学评估量表评估认知功能,分为MMSE和全套量表测试两组:MMSE测试组于术前及术后1、3、5、7 d单独应用MMSE,全套量表测试组在术前及术后第7天采用全套量表评估。结果 MMSE评分随测验次数的增多而升高,所诊断的认知功能障碍发生率逐次下降,在术后第7天时明显低于全套量表评估所得发生率。全凭静脉麻醉后认知功能障碍发生率略低于静吸复合组,但差异无统计学意义。结论全套量表较MMSE更适于评估老年病人术后早期认知功能,全凭静脉和静吸复合麻醉对术后早期认知功能影响的差异无统计学意义。

Objective To study the strategies in assessing early postoperative cognitive dysfunction（POCD） in elderly patients underwent non-cardiac surgery with total intravenous anesthesia（TIVA） or intravenous-inhalation combined anaesthesia.Methods 142 patients who were older than 65 years were enrolled in this study.Patients were divided into two groups.Methods of general anaesthesia include total intravenous anesthesia and intravenous-inhalation combined anaesthesia.Cognitive function was evaluated by mini-mental-status examination（MMES）,digit span test,digit symbol substitution test,trail making test and comprehension memory subtest.Group A was tested with MMSE on one day before surgery,on the 1st,3rd,5th and 7th postoperative day.Group B was tested with five neurocognitive test batteries preoperatively and on the 7th day postoperatively.Results MMSE scores were increasing with test times and the incidence of POCD was declined accordingly.The incidence of POCD in patients with TIVA had a lower tendency than that with intravenous-inhalation combined anaesthesia on 7th day postoperatively;however the difference was no statistical significance.Conclusion The five neurocognitive test batteries might be more effective than MMSE in evaluating early POCD in elderly patients.There were no statistical difference in the incidences of POCD between TIVA and intravenous-inhalation combined anaesthesia.