不同麻醉方法对老年患者术后早期认知功能的影响

The Impact of Anaesthesia Type on Cognitive Function during the Early Postoperative Days in Elderly Patients

目的探讨不同麻醉方法对老年患者术后早期认知功能的影响。方法 240例老年患者依据不同麻醉方法分为局麻组80例、硬麻组80例、全麻组80例,分别于术前和术后1、3、5d应用简易智能量表(MMSE)评定其认知功能,并对另外5个可能影响老年患者术后认知功能的因素(年龄、性别、受教育程度、手术时间、术前认知功能评分)进行Logistic分析。结果全麻组术后1、3d MMSE评分降低明显(P<0.05),但全麻组与硬麻组和局麻组相比无统计学意义(P>0.05)。单因素分析有统计学意义的危险因素是年龄、手术时间和术前MMSE评分(P<0.05),多因素非条件Logistic回归分析发现,患者的年龄是一个独立危险因素(P<0.05)。结论老年患者全麻手术后早期认知功能下降明显,但不同麻醉方法对老年患者术后早期发生认知功能障碍的影响无统计学差异。年龄是老年患者术后早期发生认知功能障碍的一个有显著性意义的危险因素。

Objective To explore the impact of Anaesthesia type on cognitive function during the early postoperative days in elderlypatients Methods Two hundreds and fouty elderly patients were divided into three groups： local anesthesia group , epidural anesthesia group or general anesthesia group of 80 casas respectively. The cognitive function of the patients was assessed preoperative and on the 1st , 3rd and 5th postoperative day with the Mini Mental State Examination （ MMSE ）. According to clinical experience, five factors correlated with the complications of postoperative cognitive dysfunction （ POCD ） in elderly patient , including age, gender ,level of education, duration of operation, MMSE scores before operation , we used multiple logistic regression analysis to find risk factors .Results Compared with the baseline values the MMSE scores decreased significantly on the 1st and 3rd postoperative day in GA group（P 〈 0.05）, .There was not statistically significant between GA and LA groups or EA groups. Through univariate analysis using ehi-square, the complications of POCD were significantly associated with elderly patients＇ age, duration of operation and MMSE scores before operation（P 〈 0.05） .The results of multivariate logistic analysis showed that age was significantly correlated with the complications of POCD in elderly patients. Conclusion Elderly patients subjected to general anesthesia display more frequent cognitive impairment during the early postoperative period. But the type of anesthesia do not affect the incidence of POCD in elderly patients. Only the age is a significant risk factor of POCD in elderly patients.