两种麻醉方式对普胸外科老年患者术后中枢神经损伤及早期认知功能的影响

Influence of two different anaesthesia methods on central nerve injury and cognitive function after thoracic surgery in gerontal patients

目的比较在普胸外科手术中使用单纯全身麻醉与全身麻醉复合硬脊膜外腔阻滞麻醉对老年患者术后中枢神经损伤及早期认知功能的影响。方法选择老年普胸外科择期手术患者60例,随机分入全身麻醉组和全身麻醉复合硬脊膜外腔阻滞麻醉组(复合麻醉组),每组30例。分别于术前1d及术后1、3、7、28d采用简易智力状态检查法(MMSE)评估患者的认知功能。分别于术前1d、手术结束时和术后1d取静脉血浆检测S100β蛋白表达水平和神经元特异性烯醇化酶(NSE)质量浓度,评估患者中枢神经系统损伤情况。结果复合麻醉组术后1、3和7d的MMSE评分显著高于全身麻醉组同时间点(P值均<0.05),且均较同组术前1d显著降低(P值均<0.05)。复合麻醉组手术结束时和术后1d的血浆S100β蛋白表达水平、手术结束时的血浆NSE质量浓度均显著低于全身麻醉组同时间点(P值均<0.05),且均较同组术前1d显著升高(P值均<0.05)。两组间术前1d的MMSE评分、血浆S100β蛋白表达水平和血浆NSE质量浓度,术后1d的血浆NSE质量浓度,以及术后28d的MMSE评分的差异均无统计学意义(P值均>0.05)。结论在老年患者普胸外科手术中应用全身麻醉复合硬脊膜外腔阻滞麻醉较单纯全身麻醉更有利于老年患者早期认知功能的恢复。

Objective To compare the effect of general anesthesia combined with epidural anesthesia versus single general anesthesia on postoperative cognitive function and central nerve injury in gerontal patients undergoing thoracic surgery. Methods Sixty elderly patients scheduled for thoracic surgery were randomly divided into general anesthesia group and general anesthesia combined with epidural anesthesia group （ n = 30）. Mini-mental state examination （MMSE） was used to all patients 1 day before surgery, and 1, 3, 7 and 28 days after surgery. Venous blood was taken to measure the concentration of S100β and neurone specific enolase （NSE） in plasma 1 day before surgery, at the end of surgery, and 1 day after surgery. Results The MMSE score of general anesthesia combined with epidural anesthesia group was significantly higher than general anesthesia group at 1, 3 and 7 days after surgery （all P〈0.05）. Compared with preoperative score, postoperative MMSE score of two groups were significantly decreased （both P〈0.05）. The concentration of S100β at the end of surgery and 1 day after surgery and NSE at the end of surgery in general anesthesia combined with epidural anesthesia group was significantly lower than those in general anesthesia group （all P0.05）. Compared with preoperative levels, postoperative S100β and NSE of two groups were significantly increased （all P〈0.05）. There was no significant difference in MMSE score between the two groups before surgery or 28 days after surgery （all P〉0.05）. Neither were the concentrations of S100β and NSE before surgery, or NSE 1 day after surgery （all P〉0.05）. Conclusion Compared to general anesthesia, general anesthesia combined with epidural anesthesia in thoracic surgery is more beneficial to the cognitive function for gerontal patients.