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比较

Comparison of Postoperative Cognitive Dysfunction in Elderly Urological Patients with Combined Epidural Anesthesia and Tracheal Intubation General Anesthesia

目的将腰硬联合麻醉与气管插管全身麻醉分别用于老年泌尿外科手术患者中,统计术后认知功能情况,比较不同麻醉方式对其认知功能的影响。方法选择2022年1月—2022年12月临沂市中心医院收治的65例老年泌尿外科行输尿管结石钛激光碎石术的患者作为研究对象,按照随机分组法划分为参照组(n=32)和联合组(n=33),分别行气管插管全身麻醉和腰硬联合麻醉。对两组患者麻醉相关指标、VAS疼痛得分、简易精神状态检查量表(MMSE)、认知功能障碍发生率的差异进行比较。结果联合组麻醉优良率高于参照组麻醉优良率,差异有统计学意义(P<0.05)。与术前比较,术后参照组、联合组VAS得分均更低,且联合组VAS得分低于参照组,差异有统计学意义(P<0.05)。与术前比较,术后参照组、联合组MMSE得分均降低,且联合组MMSE得分高于参照组,差异有统计学意义(P<0.05)。联合组术后6 h、24 h认知功能障碍发生率低于参照组,差异有统计学意义(P<0.05)。结论与气管插管全身麻醉比较,腰硬联合麻醉用于老年泌尿外科手术患者的麻醉效果更好,对认知功能的影响较小,认知功能障碍率较低,促进患者术后恢复。

Objective To compare the effects of different anesthesia methods on cognitive function in elderly patients undergoing urologic surgery by using combined epidural anesthesia and tracheal intubation general anesthesia.Methods Sixty-five elderly urological patients who underwent titanium laser lithotripsis for ureteral calculi admitted to our hospital from January 2022 to December 2022 were selected as the study objects,and were divided into general anesthesia group(32 cases)and combined anesthesia group(33 cases)according to randomization rule,and received tracheal intubation general anesthesia and combined epidural anesthesia,respectively.Anesthesia-related indicators,VAS pain score,brief Mental State Examination Scale(MMSE),and incidence of cognitive dysfunction were evaluated between the two groups.Results The rate of excellent and good anesthesia in combination group was 87.88%higher than that in general anesthesia group(59.38%)(P<0.05).Compared with the preoperative results,the VAS score of the general anesthesia group and the combined group was lower(P<0.05),and the VAS score of the combined group was lower than that of the general anesthesia group(P<0.05).Compared with the preoperative results,the MMSE scores in both the general anesthesia group and the combined group were lower after operation(P<0.05),and the MMSE scores in the combined group were higher than those in the general anesthesia group(P<0.05).The incidence of cognitive dysfunction 6 h and 24 h in the combined group was lower than that in the general anesthesia group(P<0.05).Conclusion Compared with tracheal intubation general anesthesia,lumbo-epidural anesthesia has better anesthetic effect,less influence on cognitive function,lower rate of cognitive dysfunction,and can promote postoperative recovery of patients.