硬膜外麻醉与全身麻醉对老年患者术后不同时点认知功能的影响比较

The Effect of Epidural Anesthesia and General Anesthesia on Postoperative Cognitive Function in Older Patients

目的探讨硬膜外麻醉与全麻对老年手术患者术后不同时点认知功能的影响。方法收集我院进行手术且均施行术前麻醉的患者116例,采用随机数字表法将其分为观察组与对照组,每组各58例,观察组采用硬膜外麻醉法进行麻醉,而对照组采用全身麻醉法进行麻醉,对两组患者不同时点的简易智力量表(MMSE)评分进行描述,采用重复测量方差分析对其进行比较,并对两组患者术后不同时点产生认知功能障碍的情况进行比较。结果两组患者麻醉前的MMSE评分均最高,术后3 h的MMSE评分均最低,之后又逐渐升高;用重复测量方差分析进行比较发现对照组和观察组的MMSE评分之间的差异无统计学意义(P>0.05),而麻醉方式和时间之间不存在交互作用(P>0.05);观察组术后3 h及6 h的认知功能障碍的发生率(13.79%和5.17%)均低于对照组(29.31%和17.24%),差异具有统计学意义(P<0.05),而术后1 d两组的认知功能障碍发生率差异无统计学意义(P>0.05)。结论硬膜外麻醉法患者术后3 h及6 h的认知功能障碍发生率低于全麻组,说明硬膜外麻醉对老年患者术后的认知功能的影响较低,推荐在临床上推广使用。

Objective To explore the effect of epidural anesthesia and general anesthesia on postoperative cognitive function in older patients. Methods 116 patients with preoperative anesthesia were randomly divided into the observation group (58 cases) and control group (58 cases) The observation group was given epidural anesthesia. The control group was given general anesthesia. The mini mental state examination ( MMSE) was assessed. The appearance of cognitive dysfunction at different time points was recorded. Results MMSE scores in both groups were decreased at 3 h after surgery, after then increased gradually, but there was no significant difference between the control group and the observation group ( P> 0.05 ). There was no interaction between anesthesia methods and time ( P> 0.05 ). The incidences of postoperative cognitive dysfunction in the observation group at 3 h and 6 h (13.79% and 5.17%) were lower than those in the control group (29. 31% and 17. 24%)(P< 0.05 ), however, there was no significant difference 1 d after surgery between the two groups (P> 0.05). Conclusion Epidural anesthesia has less influence on postoperative cognitive function in older patients.