不同麻醉方式对老年患者术后早期认知功能的影响比较

Effect comparison of different methods of anesthesia on early postoperative cognitive function in elderly patients

目的研究不同麻醉方式对老年患者术后早期认知功能障碍的影响。方法选取怀化市第一人民医院收治的ASAⅠ～Ⅱ级行非心脏手术的老年患者100例，将其随机分为A组和B组，每组50例，A组采用静吸复合、气管内插管（全身麻醉），B组则采用腰麻联合硬膜外麻醉（椎管内麻醉），以MMSE量表对比两组患者出麻醉恢复室时及术后1、3、7d的认知功能障碍。结果两组患者在出麻醉恢复室时及术后1d的MMSE评分与术前比较均明显下降（P〈0．05），A组降低幅度高于B组（P〈0．05）；A组患者出麻醉恢复室时、术后1d认知功能障碍的发生率分别为40％、28％，B组为20％、12％，差异有统计学意义（P〈0．05）。术后3、7d患者MMSE评分组间比较差异未见统计学意（P〉0．05）。结论采用全身麻醉比采用椎管内麻醉对老年患者术后早期认知功能障碍具有更大影响，更易导致老年患者术后发生认知功能障碍。

Objective To study the effect of different methods of anesthesia on early postoperative cognitive function in elderly patients. Methods One hundred elderly patients ASA I-II level with non-cardiac surgery were selected. They were randomly divided into group A and group B, with 50 cases in each group. Patients in group A were given inhalational combined with endotracheal intubation （ general anesthesia） , patients in group B were given combined spinal and epidural anesthesia（ spinal anesthesia） , when the PACU and 1, 3, 7 d postoperative, cognitive dysfunction of the two groups were compared by MMSE scale. Results MMSE score at the time of the PACU, 1 d postoperative of the two groups decreased significantly compared with preoperative （P 〈 0. 05 ） , and the MMSE score of group A decreased significantly than that of group B （P 〈 0.05 ） ; The incidence of cognitive dysfunction when the PACU and 1 d postoperative of group A was respectively 40% , 28% , that in group B was 20% , 12% , the differences were significant（P 〈 0. 05）. The MMSE scores after 3, 7 d postoperative between the two groups had no significant difference （ P 〉 0.05 ）. Conclusions General anesthesia compared with spinal anesthesia have a greater impact on early postoperative cognitive dysfunction in elderly patients, more likely to lead to postoperative cognitive dysfunction for elderly patients.