全身麻醉与硬膜外腔阻滞对老年骨科患者术后短期认知功能的影响比较

Effects of general anesthesia and epidural block anesthesia on short -term cognitive function of elderly orthopedics patients

目的比较全身麻醉与硬膜外腔阻滞对老年骨科患者术后短期认知功能的影响。方法选取宁波市第六医院2015年1月至2017年3月收治的老年骨科手术患者80例作为观察对象,根据麻醉方式的不同进行分组,采用全身麻醉的40例患者为全麻组,采用硬膜外腔阻滞的40例患者为硬麻组,比较两组不同时间认知功能情况。结果两组在手术过程中的动脉血压、心率等差异无统计学意义(P>0.05);全麻组在麻醉后6 h、12 h、24 h的简易精神状况检测量表(MMSE)评分[(26.4±0.7)分、(25.9±0.5)分、(29.2±0.8)分]与麻醉前比较差异明显[(29.1±1.1)分,t=6.235,P<0.05],硬麻组在麻醉后6 h、12 h的MMSE评分[(26.5±0.4)分、(25.8±0.7)分]与麻醉前[(29.2±0.8)分]比较差异明显(t=5.123,P<0.05);麻醉后24 h组间比较:硬麻组(29.5±0.7)分,明显高于全麻组的(27.2±0.8)分(t=13.684,P<0.05);麻醉后6 h、12 h:全麻组的术后认知功能障碍发生率(17.50%、20.00%)显著高于硬麻组(7.50%、5.00%)(χ^2=4.571、10.285,均P<0.05)。结论实施全身麻醉对老年骨科患者术后认知功能的影响显著大于硬膜外腔阻滞。

Objective To compare the effects of general anesthesia and epidural block anesthesia on postoperative short-term cognitive function of elderly orthopedic patients.Methods From January 2015 to March 2013,80 elderly patients with orthopedic surgery in the Sixth Hospital of Ningbo were selected in the research,According to the anesthesia method,40 patients received general anesthesia were enrolled into general anesthesia group,40 patients received epidural anesthesia were enrolled into epidural group.The cognitive function of different time were compared between the two groups.Results There were no statistically significant differences in blood pressure and heart rate between the two groups (all P>0.05). The simple mental health scale (MMSE) scores at 6h,12h,24h after anesthesia in the general anesthesia group were (26.4±0.7)points,(25.9±0.5)points,(29.2±0.8)points,respectively,compared with that before anesthesia[(29.1±1.1)points],the difference was statistically significant (t=6.235,P<0.05). The MMSE scores at 6h,12h after anesthesia in the epidural group were (26.5±0.4)points,(25.8±0.7)points,compared with that before anesthesia[(29.2±0.8)points],the difference was statistically significant (t=5.123,P<0.05). The MMSE score at 24 h after anesthesia in the epidural group was (29.5±0.7)points,which was obviously higher than (27.2±0.8)points in the general anesthesia group (t=13.684,P<0.05). The incidence rates of postoperative cognitive dysfunction (POCD) at 6h,12h after anesthesia in the general anesthesia group (17.50%,20.00%) were significantly higher than those in the epidural group (7.50,5.00%)(χ^2=4.571,10.285,all P<0.05).Conclusion The effect of general anesthesia on postoperative cognitive function is significantly greater than that of epidural anesthesia.