不同麻醉方式对老年患者术后认知能力的影响

Influence of different anesthesia methods on postoperative cognitive ability of elderly patients

目的通过简易智能状态检查法(MMSE),调查3种不同麻醉方法对老年患者术后早期认知功能的影响。方法将285例老年手术患者随机分为全身麻醉复合硬脊膜外阻滞组(GEA组)、单纯全身麻醉组(GA组)和硬膜外麻醉组(EID组),每组各95例。分别在术前及术后12、24、72 h、第7天和1个月,对患者采用MMSE进行神经、精神功能评定。结果术后认知障碍(POCD)主要发生在术后24 h内,术后第7天除GA组有2例POCD外,其余均恢复正常;GA组出现POCD的比例最大、最为严重,GEA组次之,3组之间差异有统计学意义(P<0.05);术后1月POCD患者均恢复正常。结论硬膜外麻醉、单纯全身麻醉和全身麻醉复合硬脊膜外阻滞均与老年患者手术后认知功能障碍的发生有关;全身麻醉对认知功能的影响最大,而硬膜外麻醉的影响最小;术后认知障碍持续的时间相对较短,恢复良好。

[ Objective ] By Mini-Mental State Examination （MMSE）, to investigate the influence of three different anesthetic methods on early postoperative cognitive function in elderly patients. [ Methods]285 cases of elderly surgical patients were randomly divided into the general anesthesia combined with epidural anesthesia group （ GEA group） , general anesthesia （ GA group ） and epidural anesthesia group （ EID group ） , 95 cases in each group. The nerves function and mental function were assessed by MMSE before operation and 12 hours, 24 hours, 72 hours, 7 days and one month after operation. [ Results] The postoperative cognitive dysfunction （ POCD ） occurred within 24 hours after operation i there were only 2 cases of POCD in GA group 7 days after operation and rest patients were returned to normal. The proportion of POCD in GA group was the highest , while the POCD was the most serious, followed by GEA group, and the differences between the three groups were statistically significant （ P 〈 0.05 ）. All patients with POCD were back to normal one month after operation. [ Conclusion] The epidural anesthesia, general anesthesia and general anesthesia combined with epidural anesthesia are related to the occurrence of cognitive dysfunction in elderly patients after surgery. The general anesthesia has the greatest effect on cognitive function, while the epidural anesthesia has the minimal effect. The post-operative cognitive dysfunction lasts for a short time and with a good prognosis.