依托咪酯乳剂复合硬膜外麻醉对老年妇科患者术后早期认知功能的影响

Effects of etomidate combined with epidural anesthesia on the postoperative cognitive function of elderly female patients

目的探讨依托咪酯乳剂复合硬膜外麻醉对老年妇科患者术后认知功能的影响及其机制。方法40例行腹腔镜下子宫切除术的老年患者，随机分为依托咪酯乳剂全麻组（A组）和依托咪酯乳剂复合硬膜外麻醉组（B组），每组20例。采用简易智能精神状态检查量表（MMSE）评估患者术前和术后第1,3、7天的认知功能。记录2组患者拔管时间和麻醉复苏室（PACU）治疗时间。结果B组患者拔管时间和PACU治疗时间均显著短于A组（P〈0．05）。2组患者术前、术后第3天以及术后第7天的MMSE评分比较，差异无统计学意义（P〉0．05）；A组患者术后第1天MMSE评分显著低于B组（P〈0．05）。结论相对于依托咪酯乳剂全凭静脉麻醉，使用依托咪酯乳剂复合硬膜外麻醉对术后早期认知功能的影响更小。

Objective To evaluate the effects of etomidate combined with epidural anesthesia on the postoperative cognitive function of elderly female patients. Methods A total of 40 elder patients scheduled for laparoscopic total hys- terectomy were randomly divided into two groups： an etomidate group （Group A） and an etomidate combined with epi- dural anesthesia group （ Group B） （ n = 20）. Their cognitive function was assessed before operation and 1, 3 and 7 days after operation by mini -mental state examination （MMSE）. The time of extubation and treatment in PACU were recor- ded. Results There was no significant difference in MMSE score between two groups before operation and 3 and 7 days after operation （ P 〉 0.05 ）. Meanwhile, Group A showed remarkably reduced MMSE scores than Group B 1 day after op- eration （ P 〈 0.05 ）. The time for extubation and treatment in PACU in Group A were significantly longer than those in Group B （ P 〈 0.05 ）. Conclusions Etomidate combined with epidural anesthesia produce less effect on the postopera- tive cognitive function in elder patients undergoing laparoscopic total hysterectomy.