颈动脉粥样硬化对老年全身麻醉患者术后认知功能的影响

The effect of carotid artery atherosclerosis on the cognition function of elder patients after general anesthesia

目的探讨颈动脉粥样硬化对老年全身麻醉患者术后认知功能的影响。方法选择接受全身麻醉手术并经由颈动脉超声诊断为颈动脉粥样硬化的老年患者48例为观察组,并选取同期进行全身麻醉手术的无颈动脉粥样硬化的老年患者56例为对照组,分别在术前24 h,术后24、72 h,1、4、12周对患者进行简易精神状态量表(MMSE)评分。结果术后24 h两组的MMSE评分均低于术前(P<0.05),并且观察组较对照组MMSE评分更低(P<0.05);在认知功能障碍方面术后24 h观察组有12例而对照组有5例,差异有统计学意义(P<0.05);在术后72 h,1、4、12周两组的MMSE评分较术后24 h有所上升,但是两组之间仍差异有统计学意义(P<0.05),且观察组认知功能障碍患者的比率均高于对照组(P<0.05);对照组在术后72h MMSE评分基本恢复到术前水平(P>0.05),仅有1例患者MMSE水平随访到12周仍低于正常;而在观察组随访至12周,平均MMSE水平仍未恢复至术前水平(P<0.05),且有6例患者仍有认知功能障碍。结论颈动脉粥样硬化的老年患者在接受全身麻醉手术后更易造成术后认知功能障碍,因此要积极的筛查此类患者并探索更好的对认知功能影响更小的麻醉方式。

Objective To explore the effect of carotid artery arteriosclerosis( CAA) on the postoperative cognitive dysfunction( POCD)of elder patients after general anesthesia. Methods A total 48 elder patients with CAA were assigned as study group and 56 non-CAA elder patients as control group. All these patients accepted a unified standard anesthetic protocol by two high qualification Anesthetists.MMSE score was evaluated: 24 h before surgery and 24,72 h,1,4 and 12 W after surgery. Results 24 h after surgery the MMSE score decrease in both groups( P < 0. 05). The mean MMSE score of observation group was lower than control group at all the time point postsurgery( P < 0. 05). There were 12 patients with POCD in the control group while only 5 patients were detected in the control group at24 h after surgery( P < 0. 05). After 12 W follow up study,the MMSE score restored to the level of pre-surgery in the control group( P> 0. 05),while in the observation group the MMSE score still lower than the level of pre-surgery( P < 0. 05). After 12 W follow up study six patients in the observation group still with POCD while only one patient with POCD in the control group( P < 0. 05). Conclusions The elder patients with CAA may be more easier to develop to POCD when accept general anesthesia,thus it is important to explore anesthesia protocol which has a less effect on the cognitive function for these patients.