不同麻醉和镇痛方法对老年患者非心脏手术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 Non-cardiac Surgery

目的研究观察不同麻醉和镇痛方法对老年患者非心脏手术术后早期认知功能的影响。方法方便选取2017年11月—2018年10月该院接受非心脏手术的老年患者68例作为该次的研究对象,将所有纳入研究的患者按照数字随机表法对照组和试验组两组,各34例。其中,对照组患者采取全身麻醉联合术后静脉注射镇痛药治疗,试验组患者采用腰硬联合麻醉术后硬膜外镇痛疗法,对比两组老年患者的术后24h和36h精神状态和术后一周认知功能障碍情况以及术后12h、24h、36h患者的疼痛状况。结果试验组老年患者精神状态评分术后24h(23.17±1.38)分和36h(25.24±1.02)分均高于对照组(t=7.260,4.233,P<0.05),试验组术后1周认知功能障碍发生率为5.88%低于对照组26.47%(χ^2=5.314,P=0.021),试验组老年患者VAS评分术后12h(3.19±1.12)分、24h(2.23±0.50)分、36h(1.05±0.29)分与对照组相比,差异无统计学意义(t=0.074,0.163,0.275,P>0.05)。结论对老年非心脏手术的患者采用腰硬联合麻醉术后硬膜外镇痛疗法比全身麻醉联合静脉注射镇痛药对认知功能的影响小,值得在临床上应用推广。

Objective To study the effects of different anesthesia and analgesia methods on early cognitive function in elderly patients after non-cardiac surgery. Methods Sixty-eight elderly patients who underwent non-cardiac surgery in our hospital from November 2017 to October 2018 were enrolled. The patients in the study were randomized to the control group and the experimental group, 34 cases each. Among them, the patients in the control group were treated with general anesthesia combined with postoperative intravenous analgesics. The patients in the experimental group were treated with epidural analgesia after combined spinal and epidural anesthesia. The postoperative 24h and 36h mental status of the elderly patients were compared, as well as the pain dysfunction and postoperative pain at 12h, 24h, and 36h after surgery. Results The scores of mental status of the elderly patients in the experimental group were higher than those in the control group at 24h (23.17±1.38)points and 36 h (25.24±1.02)points,(t=7.260, 4.233, P<0.05). The incidence of dysfunction was 5.88% lower than that of the control group 26.47%(χ^2=5.314, P=0.021). The VAS score of the elderly patients in the experimental group was 12h (3.19±1.12)points, 24 h (2.23±0.50)points, 36 h (1.05±0.29)points after operation. There was no statistically significant difference between the and the control group (t=0.074, 0.163, 0.275, P>0.05). Conclusion The postoperative epidural analgesia therapy for elderly patients with non-cardiac surgery combined with general anesthesia combined with intravenous analgesics has little effect on cognitive function, and it is worthy of clinical application.