利多卡因联合丁卡因硬膜外麻醉对老年创伤患者术后早期认知功能的影响

Effects of Lidocaine Combined with Epidural Anesthesia on Early Postoperative Cognitive Function in Elderly Patients After Surgery

目的:探讨利多卡因联合丁卡因硬膜外麻醉对老年创伤患者术后早期认知功能的影响。方法:选取2013年3月—2015年2月汉川市人民医院收治的老年股骨手术患者100例作为研究对象。将所选患者以随机数字表法分为全麻组和硬膜外组,每组各50例。全麻组患者采用全身麻醉,硬膜外组患者采用单侧硬膜外麻醉方式。测定并比较2组患者术前、术后的认知状况。结果:术前3 h,2组患者简明精神状态检查量表(mini-mental state examination,MMSE)评分的差异无统计学意义(P>0.05);术后2 d,硬膜外组患者MMSE评分显著高于全麻组,差异有统计学意义(P<0.05);硬膜外组患者术前、术后MMSE评分的差异无统计学意义(P>0.05);全麻组患者术后2 d的MMSE评分显著低于术前3 h,差异有统计学意义(P<0.05)。硬膜外组患者认知功能障碍发生率为22%(11/50),显著低于全麻组的42%(21/50),差异有统计学意义(P<0.05)。结论:对于老年创伤患者,采用硬膜外麻醉相对于全身麻醉效果更好,术后患者认知功能障碍发生率较低。

OBJECTIVE： To probe into the effects of lidocaine combined with epidural anesthesia on early postoperative cognitive function in elderly patients after surgery. METHODS： 100 elderly patients with femoral surgery admitted into Hanchuan People＇s Hospital from Mar. 2013 to Feb. 2015 were selected to be divided into general anesthesia group and epidural group via the random number table,with 50 cases in each. The general anesthesia group were treated with general anesthesia,while the epidural group received unilateral epidural anesthesia. Before and after surgery,the cognitive status of patients were determined and compared. RESULTS： Before surgery of 3 h,there was no statistically significant difference between two groups in MMSE score（ P〉0. 05）. After surgery of 2 d,the MMSE score of epidural group was significantly higher than that of general anesthesia group,with statistically significant difference（ P〈0. 05）; yet there was no statistical significance of MMSE score in epidural group before and after surgery（ P〉0. 05）; after surgery of 2 d,the MMSE score in general anesthesia group was significantly lower than that of before surgery of 3 h,the difference was statistically significant（ P〈0. 05）. The incidence of cognitive dysfunction of epidural group was 22%（ 11 /50）,significantly lower than that of general anesthesia group [42%（ 21 /50） ],the difference was statistically significant（ P〈0. 05）. CONCLUSIONS： The effects of epidural anesthesia are better than those of general anesthesia for elderly patients after surgery,with low incidence of cognitive dysfunction after surgery.