不同麻醉方式对老年患者术中及术后MAP、SPO_2、HR的影响及术后认知功能分析

Influence of Two Anesthetic Methods on MAP,SPO_2,HR and Postoperative Cognitive Dysfunction of Senile Patients

目的观察比较全身麻醉和外周神经阻滞麻醉对老年手术患者血流动力学以及术后认知功能的影响。方法回顾性分析2016年7月至2017年8月期间在我院普外科和骨科进行手术治疗的老年患者204例,分为全身麻醉组(A组100例)和外周神经阻滞组(B组104例)。监测并记录患者麻醉诱导前(t0)、手术中(t1)、手术结束时(t2)以及手术后30 min(t3)患者的心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO_2)、脑电双频指数(BIS);并对患者术前及术后1 h、术后4 h、术后12 h、术后1 d和3 d进行MMSE检测评估认知功能障碍(POCD)发生情况。结果外周神经阻滞患者的麻醉诱导时间长于全身麻醉患者(P<0.05),而麻醉药物的使用量却少于全麻组患者(P<0.05)。A组患者术后1 h、术后4 h和术后12 h,MMSE评分较术前均有所降低(P<0.05);而外周神经阻滞患者只有在术后1 h时,MMSE评分较术前有所降低(P<0.05),但是术后4 h起逐渐恢复,与术前比较,没有统计学差异(P>0.05)。另外,B组患者术后1 h、术后4 h和术后12 h,MMSE认知功能评分均高于A组患者,有统计学差异(P<0.05)。术后1 h、4 h、12 h时,B组患者POCD发生率明显低于A组患者(P<0.05)。结论外周神经阻滞麻醉的老年手术患者术中和术后血流动力学指数较全身麻醉患者更稳定,麻醉药物使用量更少,术后对患者认知功能的损伤更轻,POCD的发生率更小。

Objective To observe and compare the effect of general anesthesia and peripheral nerve blocks on hemody-namics and postoperative cognitive dysfunction （ POCD） of senile patients. Methods Two hundred and four senile patients treated surgically in our hospital were selected as subjects and divided into the general anesthesia group （group A,n=100） and peripher-al nerve blocks group （group B, n=104）. The patients＇heart rate （HR）, mean arterial pressure （MAP）, pulse oxygen satura-tion （ SPO2 ） and BIS were recorded before induction of anesthesia （ t0 ） , intraoperatively （ t1 ） , postoperatively （ t2 ） , and 30 min after surgery （ t3 ） . Meanwhile, the POCD of patients before surgery, 1 h, 4 h, 12 h, 1 d, 3 d after surgery was measured with MMSE. Results The mean induction time of anesthesia in group B was longer than in group A （P〈0. 05）, and the anesthetic do-ses were lower than in group A （P〈0. 05）. The mean MMSE scores of patients in group A were all lower 1 h, 4 h, and 12 h af-ter surgery （P〈0. 05）, but were lower in group B only 1 h after surgery （P〈0. 05） and began to recover 4 h after surgery. Be-sides, the mean MMSE scores of patients in group B 1 h, 4 h, and 12 h after surgery were all higher than in group A （P〈0. 05）. The incidence of POCD in group B 1 h, 4 h, and 12 h after surgery was lower than in group A （P〈0. 05）. Conclu-sion Peripheral nerve blocks can contribute more to the stability of hemodynamics, require less anesthetic drugs, cause less post-operative cognitive dysfunction than general anesthesia for senile patients.