全身与局部麻醉对老年急性出血性脑卒中患者术后认知功能的影响比较

Comparative Analysis of the Effects of General Anesthesia and Local Anesthesia on Postoperative Cognitive Function in Elderly Patients with acute Hemorrhage Strokes

[目的]比较全身与局部麻醉对老年急性出血性脑卒中患者术后认知功能的影响。[方法]72例急性出血性脑卒中患者，随机分为两组，A组给予全身麻醉，B组予以局部麻醉，记录麻醉前（T0）、手术前（T1）、手术0．5h（T2）、手术操作（T3）、术毕（T4）时患者心率（HR）、动脉压（MAP）变化，比较两组镇痛效果，术后认知功能障碍（POCD）发生率，记录术后不良反应发生率。[结果]①T。点，两组MAP、HR相比较差异无显著性（P〉0．05）；T1、T2、T3、T4点两组MAP降低，HR略有上升，但组间比较差异均无显著性（P〉0．05）；②术后即刻、术后1d、术后3dA组视觉模拟评分（VAS）均低于B组（P〈0．05）；③术前两组简易智能精神状态量表（MMSE）评分无差异（P〉0．05），术后3h、术后1dA组MMSE评分均低于B组（P〈0．05），术后3dA组MMSE评分上升，与B组比较差异无显著性（P〉0．05）；④两组睁眼、拔管及完全苏醒时间相比较差异无显著性（P〉0．05）；⑤A组术后POCD发生率略高于B组，但差异无显著性（P〉0．05），两组不良反应发生率比较差异无显著性（P〉0．05）。[结论]全身麻醉、局部麻醉对老年急性出血性脑卒中患者血流动力学影响相似，患者术后POCD发生率无差异，但全身麻醉镇痛完全，可提高患者对手术的耐受性。

[Objective] To compare the effects of general anesthesia and local anesthesia on postoperative cognitive function in elderly patients with acute hemorrhage strokes. [MethodslA total of 72 cases of acute hemorrhage stroke patients admitted into our hospital were selected and divided into group A and group B by the random number table method, with 36 cases in each group. Group A was given general anesthesia while group 13 was given local anesthesia. The changes in heart rate （HR） and mean arterial pressure （MAP） were recorded before anesthesia （T0）, before operation （T1）, after 0.5h of operation （T2）, on operation procedures （T3）, and at the end of operation （T4）. The analgesic effects were compared between the two groups. The visual analogue scale （VAS） was used to evaluate the changes in pain scores of the two groups immediately after operation, in postoperative ld, and in postoperative 3d. The eyeopening time, extubation time, and complete recovery time of the two groups were recorded. The changes in cognitive funetion before operation and 3h, 1d, and 3d after operation were evaluated on the mini-mental state examination scale （MMSE）. The incidence of postoperative cognitive dysfunction in the two groups was statistically analyzed, and the incidence of adverse reactions was recorded. [Results]（1） At T0, there was no significant difference between the MAP and HR of the two groups （ P 〉0.05）. At T1 , T2, T3, and T4, MAP of the two groups decreased while HR increased slightly. However, the differences between the groups were not statistically significant （ P 〉0.05）. （2）Immediately after operation, in postoperative 1d, and in postoperative 3d, the VAS scores of group A were lower than those of group B （ P 〈0.05）.（3）Before operation, the difference in MMSE scores between the two groups was not significant （ P 〉0.05）. After operation 3h and ld, MMSE scores of group A were lower than those of group B （ P 〈0.05）. After operation 3d , there was no significant difference in MMSE scores between group A and group B （ P 〉0.05）. （4）The differences in eye-opening time, extubation time, and complete recovery time between the two groups were not statistically significant （ P 〉0.05）. （5）The incidence of cognitive impairment in group A after operation was higher than that in group B, but the difference was not statistically significant （ P 〉0.05）. There also was no significant difference in the incidence of adverse reactions between the two groups （ P 〉0.05）. [Conclusion]The hemodynamic effects of general anesthesia and local anesthesia in elderly acute hemorrhage stroke patients are similar. There is no significant difference in the incidence of postoperative cognitive dysfunction. However, general anesthesia is complete, which can improve the tolerance of patients for surgery.