不同麻醉方式对老年经尿道前列腺电切术后血清兴奋性氨基酸水平及认知功能的影响

Influence of different anesthetic methods on postoperative serum excitatory amino acid(EAA) levels and cognitive function of elderly patients operated with transurethral resection of prostate(TURP)

目的探讨不同麻醉方式对老年经尿道前列腺电切(TURP)术后血清兴奋性氨基酸水平及认知功能的影响。方法选取我院麻醉科择期行TURP手术治疗的老年前列腺增生患者100例。依据麻醉方式不同分为全麻组(n=50)和硬膜外组(n=50),分别采用气管插管全麻和硬膜外麻醉。观察并记录两组患者麻醉前与术后4 h、8 h、1 d、4d血清兴奋性氨基酸(EAA)水平及认知功能的变化情况。结果两组患者术后4 h、8 h和1 d血清EAA水平均较麻醉前升高(P<0.05),且硬膜外组升高幅度明显低于全麻组(P<0.05);同时两组患者术后4 h、术后8 h和术后1 d MMSE评分较麻醉前下降(P<0.05),且硬膜外组下降幅度明显低于全麻组(P<0.05)。术后4 d两组患者血清EAA水平和MMSE评分均恢复至麻醉前水平(P>0.05)。结论硬膜外麻醉和气管插管全麻用于老年TURP术均可影响患者术后早期认知功能,前者对患者早期认知功能影响较轻,这可能与硬膜外麻醉升高血清EAA水平幅度较小密切相关。

Objective To discuss influence of different anesthetic methods on postoperative serum excitatory amino acid （EAA） levels and cognitive function of elderly patients operated with transurethral resection of prostate （TURP）. Methods A total of 100 cases of elderly patients with benign prostatic hyperplasia （BPH）, in Department of Anesthesiol-ogy of the hospital to be given the TURP operation at certain time were selected, and divided into general anesthesia group （n=50） and epidural group （n=50） in accordance with different anesthetic methods, who were given intubation anesthesia and epidural anesthesia respectively. The changes of serum EAA levels and cognitive function before anes-thesia, 4 hours, 8 hours, one day and four days after the operation of patients in two groups were observed and record-ed. Results Serum EAA levels 4 hours, 8 hours and one day after the operation of patients in two groups rose than be-fore （P〈0.05）, and the rising rates in epidural group were much lower than those in general anesthesia group （P〈0.05）. Meanwhile, MMSE scores of patients in two groups 4 hours, 8 hours and one day after the operation declined than be-fore （P〈0.05）, and the declining rates in epidural group were much lower than those in general anesthesia group （P〈0.05）. Four days after operation, the serum EAA levels and MMSE scores of patients in two groups returned to the levels before anesthesia （P〉0.05）. Conclusion Both intubation anesthesia and epidural anesthesia have effect on early cogni-tive function of elderly patients operated with TURP, and the former has less influence on early cognitive function of patients, which may have close effect on the lower rising rate of serum EAA level by epidural anesthesia.