全身麻醉与硬膜外麻醉对老年骨科患者术后认知功能的影响

Effect of epidural anesthesia and general anesthesia on postoperative cognitive function in elderly patients

目的探讨硬膜外麻醉在减少对老年骨科患者术后认知功能的影响，为选择科学麻醉方法提供借鉴。方法2013年1月至2015年6月本院骨科行骨折切开复位内固定的老年患者中随机选取200例作为观察对象，根据随机数表法分为观察组和对照组，各100例。比较两组患者术中平均动脉压、心率情况，同时借助简易精神状况检查量表（MMSE）对患者不同麻醉时间段的认知功能进行评分。结果观察组与对照组麻醉时间分别为（191．5±30．6）min和（89．5±27．6）min、出血量分别为（345．7±58．1）ml和（40．2±57．5）m1、输液量分别为（2088．6±160．5）ml和（100．5±158．9）ml、平均动脉压分别为（11．9±0．9）kPa和（1．8±0．9）kPa、心率分别为（84．1±5．7）次和（3．6±5．8）次，差异无统计学意义（P〉0．05）；两组患者在麻醉前、麻醉后6h、12h、72h认知功能MMSE评分分别为（29．2±1．1）分和（9．3±0．9）分、（26．2±0．5）分和（6．3±0．5）分、（25．4±0．5）分和（5．5±0．6）分、（29．3±0．8）分和（9．1±0．8）分，差异无统计学意义（P〉0．05），麻醉后24h，观察组患者认知功能MMSE评分为（29．4±0．7）分，高于对照组的（27．0±0．9）分，差异有统计学意义（P〈0．05）。结论硬膜外麻醉对老年骨科术后患者认知功能影响较小，麻醉效果较好，值得临床借鉴。

Objective To investigate the influence of epidural anesthesia on reducing the postoperative cognitive function of elderly orthopedic patients and PrOvide a scientific method choosing anesthesia. Methods 200 elderly bone fracture patients undertaking open reduction and internal fixation at the department of orthopedics of our hospital from January, 2013 to June, 2015 were randomly selected and divided into an observation group and a control group by random number table, 100 for each group. The intra-operative arterial pressure and heart rate were compared between these two groups. Mini-mental status examination scale （MMSE） was used to evaluate the patients＇ cognitive function. Results The anesthesia time, bleeding volume, infusion volume, mean arterial pressure, and heart rate were （ 191.5±30.6 ） min, （ 345.7±58.1 ） ml, （ 2088.6±160.5 ） ml, （ 11.9±0.9 ） kPa, and （ 84.1±5.7 ）beats/min in the observation group, and were （ 89.5±27.6 ）min, （ 40.2：t：57.5 ）ml, （ 100.5±158.9 ） ml, （ 1.8±0.9 ） kPa, and （ 3.6±5.8 ） in the control group, with no statistical differences. Before and 6, 12, and 72 h after anesthesia, the cognitive MMSE scores were （29.2±1.1） and （9.3±0.9）, （26.2 ± 0.5） and （6.3 ± 0.5）, （25.4 ± 0.5） and （5.5 ± 0.6）, and （29.3 ± 0.8） and （9.1 ± 0.8） in the observation group and the control group, respectively, with no statistical differences （P 〉 0.05）; 24 h after anesthesia, the cognitive MMSE score was （29.4 ± 0.7） in the observation group and was （27.0 ± 0.9） in the control group, with a statistical difference （P 〈 0.05 ）. Conclusion Epidural anesthesia has less effect on cognitive function in elderly orthopedic patients, so it is worth being learnt.