硬膜外麻醉与全身麻醉对老年骨科手术患者术后认知功能的影响

Effects of epidural anesthesia and general anesthesia on postoperative cognitive function in elderly patients undergoing orthopedic surgeries

目的:比较硬膜外麻醉与全身麻醉对老年骨科手术患者术后认知功能的影响。方法:选择老年骨科手术患者120例,按住院号奇偶分为观察组与对照组各60例。观察组采用硬膜外麻醉,对照组采用全身麻醉,比较两组手术各时段[麻醉前(T_0)、麻醉后10 min(T_1)、切皮时(T_2)、术后即刻(T_3)]心率(HR)、平均动脉压(MAP)水平,手术前后简易智能精神状态检查量表(MMSE)评分、β-淀粉样蛋白(Aβ)和神经元微管相关蛋白(Tau)水平及术后不良反应情况。结果:T_0、T_2、T_3时两组HR、MAP水平比较,差异均无统计学意义(P>0.05);与T_0时比较,T_1时观察组HR、MAP水平均显著降低(P<0.05),对照组仅略有降低,差异无统计学意义(P>0.05);T_2时两组HR、MAP水平均显著升高,差异有统计学意义(P<0.05);T_3时两组HR、MAP水平与T0时比较,差异均无统计学意义(P>0.05);T1时观察组HR、MAP水平均显著低于对照组,差异有统计学意义(P<0.05)。术后6、12、24 h,两组MMSE评分较术前均明显降低,但观察组MMSE评分高于对照组,差异有统计学意义(P<0.05);术后72 h两组MMSE评分比较,差异无统计学意义(P>0.05)。术后1 d,对照组Aβ和Tau水平明显升高(P<0.05)。观察组与术前比较无明显变化(P>0.05);但观察组Aβ和Tau水平均低于对照组,组间比较差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:给予老年骨科手术患者硬膜外麻醉,与全身麻醉比较麻醉效果显著,可稳定患者HR与MAP,术后清醒及意识恢复时间早、苏醒期躁动小,且能减少对患者精神状态和认知功能的影响。

Objective:To compare effects of epidural anesthesia and general anesthesia on postoperative cognitive function in elderly patients undergoing orthopedic surgeries.Methods:120 elderly patients undergoing orthopedic surgeries were selected and divided into observation group and control group according to their admission numbers,60 cases in each group.The observation group was given epidural anesthesia,while the control group was given general anesthesia.The levels of heart rate(HR)and mean arterial pressure(MAP)at each period of surgery[before anesthesia(T0),10 min after anesthesia(T1),at the time of skin incision(T2),immediately after the surgery(T3)],mini mental state examination scale(MMSE)score after the surgery,the levels ofβ-amyloid and neuronal microtubule-associated protein levels and postoperative adverse reactions were compared between the two groups.Results:There were no significant differences in the levels of HR and MAP between the two groups at T0,T2 and T3(P>0.05).Compared with T0,the HR and MAP levels of the observation group were significantly decreased at T1(P<0.05),while those of the control group slightly decreased(P>0.05);at T2,the HR and MAP levels of the two groups were significantly increased,and the differences were statistically significant(P<0.05);there were no significant differences in the HR and MAP levels of the two groups between T3 and T0(P>0.05);at T1,the HR and MAP levels of the observation group were significantly lower than those of the control group,and the differences were statistically significant(P<0.05).6,12,and 24 h after the surgery,the MMSE scores of the two groups were significantly lower than those before the surgery;but the MMSE score of the observation group was higher than that of the control group;the differences were statistically significant(P<0.05).72 h after the surgery,where was no statistical difference in the MMSE score between the two groups(P>0.05).1 day after the surgery,the levels ofβ-amyloid and neuronal microtubule-associated protein in the control group were significantly increased(P<0.05);the those of the observation group had no significant changes compared with those before the surgery(P>0.05);the levels of Aβand Tau in the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusions:Compared with general anesthesia,epidural anesthesia for the elderly patients undergoing orthopedic surgeries can stabilize the patient’s heart rate and arterial pressure indicators,accelerate to wake up and recover after the surgery,shorten the agitation during the recovery period,and can reduce the effects on the patients’mental state and cognitive function.