全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的临床观察

Clinical observation of postoperative short-term cognitive function in elder orthopaedic patients by using general anesthesia and epidural anesthesia

目的:探讨分析全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的影响。方法:回顾分析2012年9月至2013年5月于我院行骨科手术的182例老年患者,根据麻醉方法分为两组,全麻组91例实施全身麻醉,在麻醉诱导后行气管插管,插管成功后将其与麻醉呼吸机联通进行机械通气;硬膜外麻组91例实施硬膜外麻醉,于患者腰椎间行硬膜外穿刺置管并给予药物。两组均于麻醉诱导前、麻醉6h、12h、24h、48h使用简易精神状况检测(MMSE)量表评估患者认知功能。结果:两组在麻醉诱导前、麻醉24h、麻醉48h认知功能评分组间差异无统计学意义(P>0.05),全麻组在麻醉6h、12h认知功能评分显著低于硬膜外麻组,组间差异具有统计学意义(P<0.05)。结论:与全身麻醉相比,硬膜外麻醉用药少,对老年骨科患者短期认知功能影响较小,可减少老年患者术后认知障碍的发生。

Objective： To investigate and analyze the impact of general anesthesia and epidural anesthesia for postoperative short-term cognitive function in eider orthopaedic patients. Methods： A retrospective analysis in 182 cases of postoperative short-term cognitive function in eider orthopaedic patients were divided into two groups according to the method of anesthesia from Sep 2012 to May 2013 in our hospital. General anesthesia group （91 cases） were induced tracheal intubation in which patients were mechanical ventilation of anesthesia ventilator unicorn after successfully corr3pleting tracheal intubation. Epidural anesthesia group （91 cases） were given lumbar epidural catheterization and given drugs. Cognitive function in patients were assess by Mini-mental status detection （MMSE） scale before induction of anesthesia , anesthesia 6h, 12h, 24h, 48h in two groups. Results： Before induction of anesthesia, anesthesia 24h, 48h cognitive function score had no significant difference in two groups （P〉0.05）,anesthesia 6h, 12h cognitive function scores were significantly lower in general anesthesia group than that in the epidural anesthesia group in which there was statistically significant in two groups（P〈0.05）. Conclusion： Compared with general anesthesia, epidural anesthetic has less medication and less impact on short-term cognitive function, which can reduce the incidence of postoperative cognitive dysfunction in elderly patients .