全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的影响研究

Effects of General Anesthesia and Epidural Anesthesia on Short-term Cognitive Function in Elderly Patients with Orthopedics

目的探索全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的影响。方法方便选取该院2016年10月-2019年9月收治的全身麻醉和硬膜外麻醉下进行手术治疗的老年手术患者203例,按照麻醉操作方式分为全麻组93例与硬膜外组110例,全麻组手术中采取全身麻醉方式,硬膜外组则采取硬膜外麻醉法,观察两组的手术基本情况、麻醉前与麻醉操作后24 h内的认知功能。结果硬膜外组的低血压发生率20.91%与全麻组20.43%差异无统计学意义(χ^2=1.62,P=2.74);硬膜外组的术中出血量与输液量、麻醉时间分别为(351.07±63.18)mL、(2 221.37±210.65)mL、(187.96±37.18)min与全麻组(362.15±61.07)mL、(2 167.02±225.64)mL、(192.76±35.07)min对比差异无统计学意义(t=1.07、1.29、1.02,P=9.67、10.35、9.85);硬膜外组术后3 h、12 h、24 h的认知功能评分分别为(26.01±1.92)分、(27.62±1.09)分、(27.63±0.84)分,全麻组分别为(21.15±1.47)分、(24.01±1.34)分、(26.03±1.10)分,组间差异有统计学意义(t=9.65、6.81、5.79,P=0.00、0.01、0.01);全麻组术后24 h内POCD总发生率19.35%明显高于硬膜外组9.09%(χ^2=22.94,P=0.00)。结论老年骨科患者手术中采取硬膜外麻醉方式,术后24 h内的认知功能评分更高,且短期POCD的发生率也更低。

Objective To explore the effects of general anesthesia and epidural anesthesia on short-term cognitive function in elderly orthopedic patients.Methods A total of 203 elderly patients undergoing surgery under general anesthesia and epidural anesthesia treated in the hospital from October 2016 to September 2019 were convenient selected and divided into 93 cases of general anesthesia group and 110 cases of epidural group according to the method of anesthesia.In the general anesthesia group,general anesthesia was used in the operation,and the epidural group adopted epidural anesthesia.The basic conditions of surgery and the cognitive function within 24 hours after anesthesia were observed.Results The incidence of hypotension in the epidural group was 20.91%and 20.43%in the general anesthesia group was not statistically significantly different(χ^2=1.62,P=2.74).The intraoperative bleeding volume,infusion volume,and anesthesia time were(351.07±63.18)mL,(2221.37±210.65)mL,(187.96±37.18)min and general anesthesia group(362.15±61.07)mL,(2167.02±225.64)mL,(192.76±35.07)min were not significantly different(t=1.07,1.29,1.02,P=9.67,10.35,9.85);the cognitive function scores at 3 h,12 h,and 24 h after the epidural group were(26.01±1.92)points and(27.62±1.09)points,and(27.63±0.84)points,the general anesthesia group was(21.15±1.47)points,(24.01±1.34)points,and(26.03±1.10)points,and the differences between the groups were statistically significant(t=9.65,6.81,5.79,P=0.00,0.01,0.01);the total incidence of POCD in the general anesthesia group within 24 h after surgery was 19.35%significantly higher than the epidural group at 9.09%(χ^2=22.94,P=0.00).Conclusion Epidural anesthesia is used in elderly orthopedic patients during surgery.The cognitive function score is higher within 24 hours after surgery,and the incidence of short-term POCD is lower.