不同麻醉方式对老年肺癌患者围手术期认知功能的影响

Effects of different anesthesia methods on postoperative cognitive function in elderly patients with lung cancer

目的探讨硬脊膜外阻滞麻醉或全身麻醉方式对老年肺癌患者围手术期认知功能的影响。方法将93例60岁以上需择期行肺癌根治术的患者根据麻醉方式分为硬脊膜外阻滞麻醉组(观察组,46例)和全身麻醉组(对照组,47例),采用简明精神状态量表(MMSE)评估患者术前1 d、术后6 h、术后1、3、7 d的认知功能,并检测患者术前10 min、术毕30 min、术后1 d及术后3 d血清S100-β蛋白水平。结果不同的麻醉方式及术后不同时间,患者的MMSE评分差异有统计学意义,且麻醉方式和术后时间之间存在交互效应;术后6 h两组患者的MMSE评分均出现明显下降趋势(观察组:P=0.000;对照组:P=0.000);对照组术后6 h及术后1 d的MMSE评分均明显低于观察组(6 h:P=0.003;术后1 d:P=0.007);观察组术后6 h发生术后认知功能障碍(POCD)的比例明显低于对照组(13.0%vs 31.9%,P=0.030)。术后不同时间患者血清S100-β蛋白水平有显著差异,术后30 min两组患者的血清S100-β蛋白水平相比术前10 min均出现明显升高(观察组:P=0.010;对照组:P=0.000),但两组间血清S100-β蛋白水平在术后不同时点无明显差异。结论硬脊膜外阻滞麻醉方式对老年肺癌患者的术后认知功能影响较轻,患者POCD发生率低,术后认知功能恢复较快。

Objective To compare the influence of epidural anesthesia and general anesthesia on the postop -erative cognitive function in elderly patients with lung cancer .Methods Ninety-three lung cancer patients who were older than 60 years, planned for selective radical resection of pulmonary carcinoma , were assigned to receive either epidural anesthesia（observed group, n=46） or general anesthesia（control group, n=47）.Mini-mental state exami-nation（MMSE） was performed respectively at the time of preoperative 1 day, postoperative 6 hour, 1 day, 3 day and 7 day to assess the patients′cognitive function .Blood samples were collected at the moment of preoperative 10 min, postoperative 30 min, 1 day and 3 day for the detection of serum concentration of S 100-βprotein.Results Signifi-cant difference in postoperative MMSE score was associated with the methods of anesthesia and postoperative time , and there was interaction between the methods of anesthesia and postoperative time .MMSE score at the moment of post-6 h was lower than that at the time of pre-1 d in each group （ observed group： P=0.000; control group： P=0.000, respectively）, at the time of post-6 h and 1 d, the MMSE score in the control group was lower than that in the observed group（P=0.003, P=0.007, respectively）.The incidence of postoperative cognitive dysfunction （POCD） at the time of post-6 h in the observed group was lower than that in the control group （ 13.0% vs 31.9%, P=0.030 ） .Significant difference in serum S 100-βprotein level was associated with postoperative time , the serum S100-βprotein level at the time of post-30 min was higher than that at the time of pre-10 min in each of group （ observed group：P=0.010;control group：P=0.000 , respectively ）;but no significant difference of S 100-βprotein level was found between the two groups at post-30 min, 1 d and 3 d.Conclusion Epidural anesthesia exerts limited influence on cognitive function and lower incidence of POCD for elderly patients with lung cancer , compared to general anesthesia .