硬膜外麻醉联合静脉全身麻醉对老年开胸手术患者术后认知的影响

Epidural anesthesia combined intravenous general anesthesia on postoperative cognitive in elderly patients with open thoracic surgery

目的观察硬膜外麻醉联合静脉全身麻醉对老年开胸手术患者认知功能障碍（post operative cognitive dysfunction,POCD）的影响。方法选择老年开胸手术患者90例,随机分为试验组和对照组各45例。试验组采用硬膜外麻醉联合静脉全身麻醉下手术,对照组采用静脉全身麻醉下手术。2组均采用脑电双频指数（bispectral index,BIS）进行术中检测,采用靶控输注微量泵调整丙泊酚的用量。BIS值均控制在40～50。应用简易智能状态列表（Mini Mental State Examination,MMSE）对2组患者术前,术后24、48h进行评价,记录POCD发生情况。结果术后24h MMSE评分均明显下降,术后48h再明显升高,试验组波动幅度小于对照组（P〈0.05）。试验组术后24hPOCD发生率低于对照组（P〈0.05）。试验组与对照组麻醉时间比较差异无统计学意义（P〉0.05）,试验组丙泊酚和瑞芬太尼用药量明显少于对照组（P〈0.05）。结论硬膜外麻醉联合静脉全身麻醉与单纯全身静脉麻醉对比术后POCD发生率更低,手术更安全,值得在临床中推广应用。

Objective To observe the epidural anesthesia combined intravenous general anesthesia on cognitive dysfunction（post operative cognitive dysfunction,POCD）in elderly patients with open thoracic surgery.Methods Ninety elderly patients with open thoracic surgery were randomly divided into experimental group and control group（n=45）,patients with epidural anesthesia surgery under combined intravenous general anesthesia,the control group by intravenous general anesthesia surgery.Two groups all used electrical double frequency index（bispectral index,BIS）test,intraoperative using target controlled infusion trace pump adjusting the dosage of propofol.The BIS values were controlled in 40-50.Simple intelligent status list mini mental state examination（MMSE）was used in two groups of patients for evaluation before operation,after operation for 24 h,48 h,and POCD was recorded.Results MMSE score significantly decreased 24 hafter surgery,but rose,48 hsurgery,the fluctuation amplitude of experimental group was less than that of control group（P〈0.05）.POCD incidence of experimental group 24 hafter surgery was lower than that of control group（P〈0.05）.Anesthesia time showed no significant difference between two groups（P〉0.05）,the propofol and fentanyl dose of experimental group were significantly less than those of control（P〉0.05）.ConclusionEpidural anesthesia combined intravenous general anesthesia compared with simple general intravenous anesthesia showed lower incidence of postoperative POCD,safe surgery,the method is worth popularizing in clinic.