腰硬联合麻醉与气管插管全身麻醉对老年泌尿外科手术患者术后认知功能障碍的影响

Effects of combinedspinal epidural anesthesia andtracheal intubation general anesthesia onpostoperative cognitive dysfunction inelderly patients undergoing urological surgery

目的探讨腰硬联合麻醉与气管插管全身麻醉对老年泌尿外科手术患者术后认知功能障碍(POCD)的影响。方法选取2019年1月-2019年12月于绵阳市中医医院住院治疗的200例泌尿外科手术老年患者作为研究对象,依据术中麻醉方式不同,将患者分为腰硬联合麻醉组(100例)和气管插管全身麻醉组(100例)。2组均行泌尿外科手术治疗,腰硬联合麻醉组术中采用腰硬联合麻醉,气管插管全身麻醉组采用气管插管全身麻醉。对比2组围手术期相关指标(手术时间、术中出血量、液体输入量、住院费用和住院天数)、认知功能情况[简易精神状态评价量表(MMSE)评分和POCD发生率]以及不良反应发生情况。结果2组手术时间、术中出血量和液体输入量比较,差异无统计意义(P>0.05),但腰硬联合麻醉组住院时间和住院费用[(7.2±2.1)d、(13479.46±1768.45)元]均低于气管插管全身麻醉组的[(8.1±2.2)d、(15137.42±2094.27)元](P<0.05);腰硬联合麻醉组术后6 h、术后第1 d和第3 d的MMSE评分[(24.2±1.7)分、(25.6±1.5)分、(26.0±1.6)分]均明显高于气管插管全身麻醉组[(22.6±2.1)分、(23.7±1.7)分、(24.8±2.1)分](P<0.05),POCD发生率(12.0%)低于气管插管全身麻醉组(23.0%)(P<0.05)。2组麻醉相关不良反应发生率比较,差异无统计意义(P>0.05)。结论与气管插管全身麻醉比较,腰硬联合麻醉对老年泌尿外科手术患者的认知功能影响更小,且具有更高的经济性,可能为老年泌尿外科手术患者较为合适的麻醉方式。

Objective To explore the effects of combined spinal epidural anesthesia(CSEA)and tracheal intubation general anesthesia on postoperative cognitive dysfunction(POCD)in elderly patients undergoing urological surgery.Methods A total of 200 elderly patients undergoing urological surgery in the Traditional Chinese Medicine Hospital of Mianyang City from January 2019 to December 2019 were selected as the research subjects.According to different intraoperative anesthesia methods,they were divided into CSEA group(100 cases)and tracheal intubation general anesthesia group(100 cases,TIGA group).Both groups were treated with urological surgery.The CSEA group was treated with CSEA during the operation,and the TIGA group was treated with endotracheal intubation general anesthesia.The perioperative related indexes(operation time,intraoperative blood loss,fluid infusion volume,hospitalization cost,hospitalization time),cognitive function[score of Mini-Mental State Examination(MMSE),incidence of POCD]and the occurrence of adverse reactions were compared between the two groups.Results There was no significant difference in operation time,intraoperative blood loss and fluid infusion volume between the two groups(P>0.05),but the hospitalization time and hospitalization cost of CSEA group[(7.2±2.1)d,(13,479.46±1,768.45)yuan]were lower than those of TIGA group[(8.1±2.2)d,(15,137.42±2,094.27)yuan](P<0.05).At 6 h,1 d and 3 d after surgery,MMSE scores of CSEA group[(24.2±1.7)points,(25.6±1.5)points and(26.0+1.6)points,respectively]were significantly higher than those of TIGA group[(22.6±2.1)points,(23.7±1.7)points,(24.8±2.1)points,respectively](P<0.05),and incidence of POCD in CSEA group was lower than that in TIGA group(12.0%vs 23.0%)(P<0.05).There was no significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P>0.05).Conclusion Compared with endotracheal intubation general anesthesia,CSEA has less impact on cognitive function of elderly patients undergoing urological surgery,and has higher economy,which may be a more appropriate anesthesia method for elderly patients undergoing urological surgery.