全身麻醉联合硬膜外麻醉对老年患者术后认知功能的影响

Effects of Postoperative Cognitive Functioning in Elderly Patients after General Anesthesia Combined with Epidural Anesthesia

目的:探讨全身麻醉联合硬膜外麻醉在老年患者手术中的应用效果。方法:将我院2012年10月至12月收治的80例老年手术的患者随机分为观察组和对照组,对照组采用全身麻醉,观察组采用全身麻醉联合硬膜外麻醉,比较两组患者的诱导前后、插管后的心率(HR)、收缩压(SPB)、舒张压(DPB)变化,麻醉效果及用药量,并评估两组患者术后24h、术后48h、术后72h的认知功能,比较认知功能障碍(POCD)的发生率。结果:两组患者在睁眼时间、拔管时间及应答时间方面无统计学意义(P>0.05)。观察组在插管时(T2)、术中探查时(T4)、拔管时的(T4)的HR、SPB、DPB显著低于对照组(P<0.05)。观察组的全麻用药量少于对照组(P<0.05)。观察组术后的POCD发生率显著少于对照组(P<0.05)。结论:全身麻醉联合硬膜外麻醉的血液动力学较为稳定,能够显著减少老年患者麻醉后的认知功能障碍率,是一种安全、可靠的麻醉方式。

Objective：To explore a general anesthesia combined with epidural anesthesia in elderly patients with surgical application effect. Methods：Will be from October to December, 2012, 80 cases of elderly surgical patients were randomly divided into observation group and control group, control group with general anesthesia, the observation group USES the general anesthesia combined with epidural anesthesia, after comparing two groups of patients before and after induction and intubation of heart rate （HR）, systolic blood pressure （.spb）, diastolic blood pressure （DPB） under anoxic condition change, the anesthesia effect and dose, and to evaluate two groups of patients after 24 h, 48 h, 72 h after surgery, postoperative cognitive function, and compare the incidence of cognitive dysfunction （POCD）. Results：Two groups of patients in the open time, extubation time and response time of no statistical significance （P〉0.05）. Observation group at the time of intubation （T2） and intraoperative probe （T4） and extubation （T4）, HR,. spb, DPB was significantly lower than control group （P〈0.05）. Observation group of general dose less than control group （P〈0.05）. Postoperative observation group the incidence of POCD is significantly less than control group （P〈0.05）. Conclusion：General anesthesia combined with epidural anesthesia hemodynamic stable, can significantly reduce the rate of cognitive dysfunction in elderly patients after anesthesia, anesthesia is a safe and reliable way.