两种不同的麻醉和镇痛方法对老年患者非心脏手术后早期认知功能的影响

Effect of Two Different Anesthetic and Analgesic Methods on Early Noncognitive Function after Cardiac Operation in Elderly Patients

目的:探讨两种不同的麻醉和镇痛方法对老年患者非心脏手术后早期认知功能的影响。方法:选取2013年1月至2014年12月期间与我院进行治疗的老年非心脏手术患者120例,采用随机数字表法将患者随机分为两组:研究组和对照组,每组患者各60例研究组患者采用腰硬联合麻醉和硬膜外镇痛方法,对照组患者采用静脉全身麻醉的麻醉方式和静脉镇痛的镇痛方法。观察并比较两组患者的术后疼痛程度以及精神和认知功能的变化情况。结果:研究组患者在12h、24h和36h的VAS评分均显著低于对照组患者(均P<0.05)。与术前12 h比较,术后两组患者MMSE评分均降低,对照组患者术后第12h、术后第1天和术后第2天MMSE评分显著高于研究组(均P<0.05),研究组有16例患者发生术后认知功能障碍,对照组患者有29例患者发生术后认知功能障碍,研究组术后功能障碍的发生率为26.67%(16/60)显著低于对照组的48.33%(29/60)(P<0.05)。结论:腰硬联合麻醉和硬膜外镇痛的方法能够显著降低患者的术后认知功能障碍的发生率,提高患者术后生活质量。

Objective： To explore the effect of two different anesthetic and analgesic methods on early noncognitive function after cardiac operation in elderly patients. Method： 120 cases of elderly noncardiac surgery patients from January 2013 to December 2014 in our hospital were selected, they were randomly di- vided into two groups： the study group was treated by combined spinal epidural anesthesia and epidural anal- gesia, while the control group used general anesthesia and intravenous analgesia.The changes of postoperativepain degree and mental and cognitive function were observed and compared between the two groups of pa- tients. Result： The VAS scores in the study group at 12h, 24h, and 36h were significantly lower than those of the control group （ P 〈 0.05 ）. The postoperative MMSE score in the patients of two groups decreased than preoperative 12h, the MMSE scores of the control group after 12h, first day, and second day of operation were significantly higher than those of the study group （ all P〈 0.05 ） , the study group had 16 cases of cogni- tive dysfunction after operation, 29 cases in the control group had cognitive dysfunction, the rate of postoper- ative dysfunction in the study group was 26.67% （16/60）, significantly lower than 48.33%（29/60） of the control group （ P 〈 0.05 ）. Conclusion： Combined spinal epidural anesthesia and epidural analgesia can sig- nificantly reduce the postoperative incidence of cognitive impairment and improve patients＇ quality of Fife.