不同麻醉方案对老年前列腺电切术患者认知功能障碍的影响

Effect of different anesthetic programs on postoperative effects and cognitive dysfunction inquiry for elderly patients with transurethral resection of prostate

目的 观察硬膜外麻醉（CSEA）与全身麻醉（GA）对老年前列腺电切术（TURP）患者麻醉效果及认知功能障碍的影响.方法 选择接受TURP术治疗的老年患者84例,采用随机数字表法将患者分为观察组和对照组各42例.观察组实施CSEA麻醉,而对照组实施GA麻醉.统计两组患者感觉及运动阻滞情况,包括运动阻滞起效时间（MBOT）、感觉阻滞起效时间（SBOT）、运动阻滞维持时间（DMB）和感觉阻滞维持时间（DSB）及不良反应,并在术前、术后1周和术后1个月利用简易精神状态量表（MMSE）对认知功能的改善程度进行评价.结果 观察组MBOT、SBOT、DMB和DSB分别为（7.4±1.2）min、（3.0±0.2）min、（162.6±15.3）min和（97.2±15.6）min,而对照组分别为（7.8±1.5）min、（2.8±0.5）min、（224.5±15.8）min和（132.4±17.2）min,两组DMB和DSB相比,差异均有统计学意义（t=13.79、7.426,均P〈0.05）.观察组术中血压下降（7.1%比23.8%,χ^2=4.459,P=0.035）、心动过缓（2.4%比19.0%,χ^2=4.480,P=0.034）和尿潴留（4.8% 比26.2%,χ^2=7.372,P=0.007）并发症率明显低于对照组.观察组术前、术后1周和术后1个月MMSE评分分别为（28.5±2.2）分、（26.7±3.3）分和（28.0±3.6）分,对照组分别为（28.8±2.1）分、（24.8±3.2）分和（25.2±2.8）分,两组术后1周和术后1个月MMSE评分差异均有统计学意义（t=2.025、2.038,均P〈0.05）.结论 老年患者行TURP术时实施CSEA麻醉消退时间更快,且不良反应更少,对认知功能影响更小,是科学且安全可靠的麻醉方式.

Objective To observe and analyze the effect of combined spinal epidural anesthesia （CSEA） and general anesthesia（GA） on postoperative effects and cognitive dysfunction inquiry for elderly patients with transurethral resection of prostate （TURP）.Methods Eighty-four elderly patients accepted TURP in our hospital from December 2010 to January 2014 were selected.According to the principle of completely random digital table,all patients were randomly divided into observation group and control group, 42 cases in each group.The observation group was treated with CSEA, while the control group was treated with GA.Sensory and motor block situation, including motor block onset time （MBOT）,sensory block onset time （SBOT）,motor block duration （DMB） and duration of sensory blocks （DSB） and adverse reactions were recorded and compared.Mini Mental State Examination （MMSE） was used to evaluate the degree of improvement of cognitive functions at preoperative 1 week and 1 month.Results MBOT,SBOT,DMB and DSB in the observation group were （7.4±1.2）min,（3.0±0.2）min,（162.6±15.3）min and （97.2±15.6）min,respectively, which in the control group were （7.8±1.5）min,（2.8±0.5）min,（224.5±15.8）min and （132.4±17.2）min,respectively, the differences of DMB and DSB between the two groups were statistically significant （t=13.79,7.426,all P〈0.05）.Compared with the control group,the patients in the observation group got significantly lower incidence rates of decreased blood pressure （7.1% vs.23.8%,χ^2=4.459,P=0.035）,bradycardia （2.4% vs.19.0%,χ^2=4.480,P=0.034） and urine retention （4.8% vs.26.2%,χ^2=7.372,P=0.007）.MMSE scores were （28.5±2.2）points,（26.7±3.3）points and （28.0±3.6）points at preoperative 1 week and postoperative 1 month in the observation group, which in the control group were （28.8±2.1）points,（24.8±3.2）points and （25.2±2.8）points,respectively, the differences of MMSE scores at 1 week and 1 month after surgery between the two groups were statistically significant （t=2.025,2.038,all P〈0.05）.Conclusion Implementation of TURP surgery in elderly patients with CSEA anesthesia has faster subsided time, and fewer adverse reactions.It has less impact on cognitive function, thus it is one of the safe and reliable anesthesia method for elderly patients with TURP surgery.