2种麻醉方式对老年腔隙性梗死患者术后短期认知功能的影响

A comparative study of effects of combined spinal-epidural anesthesia and general anesthesia on short-term postoperative cognitive function in elderly patients with lacunar infarction

目的探讨腰-硬联合麻醉组和全身麻醉对老年腔隙性梗死患者术后短期认知功能的影响。方法选择2012年6月—2013年12月收治的行手术治疗的腔隙性梗死老年患者70例作为研究对象,按照麻醉方式分为腰-硬联合麻醉组(A组)和全身麻醉组(B组)。麻醉前、手术后,以简易智能状态检测法(MMSE)评分和蒙特利尔认知估量表(MoCA)评分对2组患者认知功能进行评价,并对2组认知功能障碍率进行统计。并运用fMRI对2组患者手术前、后脑内相关功能区的变化进行观察。结果 A组POCD发生率为12%,显著性低于B组的32%,差异有统计学意义(P<0.05)。与麻醉前比较,2组术后3 h、术后6 h、术后1 d的MMSE评分、MoCA评分显著降低,差异有统计学意义(P<0.05);A组术后3 h、术后6 h、术后1 d的MMSE评分、MoCA评分显著高于B组,差异有统计学意义(P<0.05)。fMRI结果显示,与麻醉前比较,2组患者术后脑内相关功能区激活明显;与B组比较,A组激活情况明显降低(P<0.05)。结论术前麻醉在一定程度上可损害老年腔隙性梗死患者的认知功能,腰-硬联合麻醉对患者认知功能的伤害较小,对患者脑运动相关功能区变化的影响较小。

Objective To investigate the effects of combined spinal-epidural anaesthesia（CSEA） and general anesthesia on the short-term postoperative cognitive function in elderly patients with lacunar infarction. Methods A total of 70 cases of senile lacunar infarction treated with surgery in our hospital from June 2012 to December 2013 were enrolledand divided into CSEA group（ group A） and general anesthesia group （group B） according to anesthetic methods. Before anesthesia and after surgical procedure, the postoperative cognitive of two groups were checked with Mini-Mental State assay（MMSE） score and Montreal Cognitive Assessment （ MoCA）, and postoperative cognitive dysfunction rate of bothgroups were ac- counted. The brain-related functional areas changes of both groups were also observed by functional MRI （fMRI）. Results The POCD rate of group A was 12% ,which was significantly lower than 32% in group B, the difference was sta- tistically significant（P 〈 O. 05）. Compared with the levelbefore the anesthesia,the post-operative MMSE score and MoCA scoresof bothgroups were significantly reduced, the difference was statistically significant（ P 〈 0.05 ） ; as compared with- group B, the post-operative MMSE score and MoCA scores of group A were significantly higher, the difference was statisti- cally significant（ P 〈 0.05 ）. fMRI showed thatthe related brainareas of bothgroups were significantly activated as com- pared with those before the anesthesia; ascompared withgroup B, the activation status of group A was significantly lower （P 〈 0.05）. Conclusion The preoperative anesthesiawill at some extent damage the cognitive function of elderly pa- tients with lacunar infarction;CSEA do lower the damage to cognitive function and lower the influence on the change of movement-related brain areas.