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

Influence of general anesthesia and epidural anesthesia on postoperative short-term cognitive function of elderly patients with orthopedic surgery

目的探讨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。方法选取老年骨科手术患者64例,随机分为A组和B组各32例。A组行全身麻醉,B组行硬膜外麻醉。比较2组患者麻醉时间、苏醒时间及麻醉药用量。比较2组患者麻醉前及麻醉后6、12、24、72 h的MMSE评分。比较2组患者麻醉后6、12、24、72 h的POCD发生率。结果 2组患者麻醉时间、苏醒时间及麻醉药用量无显著差异(P>0.05)。2组麻醉后6、12、24 h的MMSE评分均较同组麻醉前显著降低(P<0.05),且2组麻醉后24 h的MMSE评分比较有显著差异(P<0.05)。A组患者麻醉后6、12、24、72 h的POCD发生率高于B组,差异有统计学意义(P<0.05或P<0.01)。结论全身麻醉和硬膜外麻醉均可导致患者术后发生POCD,且以全身麻醉的发生率更高。

Objective To explore the influence of general anesthesia and epidural anesthesia on postoperative short-term cognitive function of elderly patients with orthopedic surgery. Methods A total of 64 elderly patients with orthopedic surgery were selected and randomly divided into group A and group B, 32 cases in each group. The group A was treated with general anesthesia, while the group B was treated with epidural anesthesia. The anesthesia time, recovery time and anesthetic dosage were compared between the two groups. The MMSE scores were compared before anesthesia and 6, 12, 24, 72 h after anesthesia between two groups. The incidence rate of POCD was compared at 6, 12, 24, 72 h after anesthesia between two groups. Results There were no significant differences in the anesthesia time, recovery time and anesthetic dosage between two groups(P >0.05). In both groups, the MMSE scores at 6, 12 and 24 h after anesthesia were significantly lower than those before anesthesia(P < 0.05), and there was significant difference of the MMSE score at 24 h after anesthesia between two groups(P < 0.05). The incidence rates of POCD at 6, 12, 24, 72 h after anesthesia in the group A were significantly higher than those in the group B(P < 0.05 or P < 0.01). Conclusion Both general anesthesia and epidural anesthesia can cause postoperative POCD, and the incidence rate of POCD caused by general anesthesia is higher.