不同麻醉和镇痛方法对老年患者非心脏手术后早期认知功能的影响分析

Effect of different anesthesia and analgesia methods on early cognitive function in elderly patients after noncardiac surgery

目的探究不同麻醉和镇痛方法对老年患者非心脏手术后早期认知功能影响。方法将本院收治的160例非心脏手术老年患者作为观察对象,依据麻醉及镇痛方法的不同将患者分为A组(全身麻醉静脉镇痛)和B组(腰硬联合麻醉硬膜外镇痛)各80例,比较两组患者手术前后神经精神功能评分、术后VAS评分及认知功能障碍发生率。结果 A组患者术后12 h、24 h及36 h VAS评分均显著低于B组患者,差异有统计学意义(P<0.05);B组患者术后MMSE评分均显著高于A组,差异有统计学意义(P<0.05);术后7 d,A组术后认知功能障碍发生率为43.75%,B组患者术后认知功能障碍发生率为26.25%,差异有统计学意义(P<0.05)。结论全身麻醉静脉镇痛效果优于腰硬联合麻醉硬膜外镇痛的效果,但腰硬联合麻醉硬膜外镇痛能够有效降低老年非心脏手术患者认知功能障碍发生率。

Objective To investigate the effects of different anesthesia and analgesia methods on early cognitive function in elderly patients after non-cardiac surgery.Methods 160 elderly patients with non-cardiac surgery admitted to our hospital were enrolled in the study.Patients were divided into group A(general anesthesia intravenous analgesia)and group B(lumbar and hard anesthesia combined with epidural anesthesia)according to different anesthesia and analgesia methods.Analgesia was performed in 80 patients.The neuropsychiatric scores,postoperative VAS scores,and cognitive dysfunction were compared between the two groups.Results The VAS scores of group A patients who underwent general anesthesia for intravenous analgesia were significantly lower than those of group B who underwent epidural analgesia with combined spinal and epidural anesthesia.The difference between the groups was significant(P<0.05).The MMSE scores of group B were significantly higher than those of group A(P<0.05).The incidence of postoperative cognitive dysfunction was 43.75%in group A after 7 days.Group B patients had postoperative cognitive dysfunction.The incidence rate was 26.25%,and the difference between the groups was significant(P<0.05).Conclusion The anesthesia effect of general anesthesia is better than that of combined spinal and epidural anesthesia and epidural analgesia.However,combined spinal and epidural anesthesia and epidural analgesia can effectively reduce the incidence of cognitive dysfunction in elderly patients with non-cardiac surgery.