麻醉药与手术创伤对老年患者术后早期认知功能的影响

Influence of anaesthetics and the surgical trauma on the early occurrence of postoperative cognitive dysfunction in elder patients

目的探讨麻醉药与手术创伤对老年单侧膝关节置换手术后早期认知功能的影响。方法选取单侧膝关节置换手术的老年患者180例,ASAⅠ-Ⅱ级,受教育年限≥6年,随机分为2组,每组90例:硬膜外组(EA组)和全麻组(GA组)。记录两组患者不同时间点血清皮质醇(COR)、肾上腺素(E)、去甲肾上腺素(NE)、C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白介素(IL-6)的血清浓度,并采用简易精神状态检查表(MMSE)对患者的认知功能进行评价,计算认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率。结果术毕、术后6 h、术后24 h、术后3 d、术后7 d的COR、E、NE EA组高于GA组(P<0.05);术毕、术后6 h、术后12 h、术后24 h、术后3 d、术后7 d检测血清CRP、TNF-α、IL-6 EA组高于GA组(P<0.05)。术后7 d POCD的发生率EA组高于GA组(P<0.05)。结论静脉全麻药及镇痛药能有效地抑制老年患者膝关节置换手术术中及术后应激、炎性反应,术后早期POCD的发生率下降。

Objective To investigate the influence of anaesthetics and the surgical or procedural process on the early occurrence of postoperative cognitive dysfunction （POCD） in elder patients undergoing unilateral knee replacement. Methods One hundred and eighty elder patients undergoing unilateral knee replacement were randomly divided into general anesthesia group （ GA ）, epidural anesthesia group （ EA ）, with 90 cases each, Changes of cortisol （ COR）, epinephrine （E）, norepinep-hrine （NE）, the CRP, TNF-α and IL-6 at different period were observed, the mini mental state examination （MMSE） was used to evaluate the cognitive function, and the rate of POCD was accounted. Results The levels of COR, E, NE, CRP, TNF-α and IL-6 in EA group were higher than GA group at the end of operation, 6 h,12 h, 24 h, 3 d and 7 d after surgery （P 〈 0. 05 ）. The rate of POCD in EA group were higher than GA group at 7d after surgery （P 〈 0. 05）. Conclusion The sedation and postoperative opioid analgesia can effectively reduce intraoperative and postoperative stress and inflammation response in elder patients undergoing unilateral knee replacement, and decrease the rate of POCD.