全身麻醉对骨科老年患者术后认知功能的影响

Effects of general anesthesia on postoperative cognitive function in elderly orthopedic patients

目的 观察全身麻醉对老年骨科患者术后认知功能的影响,希望为临床降低术后认知功能障碍的发生率提供参考依据.方法 2010年6月至2013年9月我院收治的骨科老年患者应用随机数字表分为全身麻醉组和硬膜外麻醉组,每组各74例.应用简易精神状态检查(MMSE)评分对两组患者手术前和手术后的认知功能进行比较分析.结果 全身麻醉组和硬膜外麻醉组患者的心率、平均动脉压、血氧饱和度以及手术相关指标比较差异均无统计学意义(P均＞0.05).两组患者MMSE评分手术后第1天[全身麻醉组(18.4±1.6)分、硬膜外麻醉组(21.2±2.5)分]、第7天[全身麻醉组(20.5±2.3)分、硬膜外麻醉组(23.4±2.1)分]均比手术前[全身麻醉组(24.4±2.2)分、硬膜外麻醉组(24.5±2.1)分]降低(F组内=13.56,P＜0.01;F组间=12.46,P＜0.01;F交互=11.80,P＜0.01.硬膜外麻醉组手术后第1、7天的认知功能障碍发生率小于全身麻醉组,但差异无统计学意义(P均＞0.05).结论 全身麻醉和硬模外麻醉都会对骨科老年患者的认知功能产生影响,但全身麻醉的影响较大.

Objective To explore the effects of general anesthesia for postoperative cognitive function in elderly orthopedic patients.Methods Elderly patients with orthopedic patients in the First People's Hospital of Shangqiu from June 2010 to September 2013 were randomly divided into general anesthesia group(n=74) and epidural group(n=74),and the cognitive functions of patients were observed by the minimum mental status examination(MMSE) score before and after treatment.Results The differences between the heart rate (HR),mean arterial pressure (MAP),pulse Oxygen Saturation (SpO2) and surgical observation indicators in both groups were not statistically significant(P＞0.05).MMSE score in general anesthesia group and epidural group decreased significantly at day 1((18.4± 1.6) point,(21.2± 2.5) point) and day 7 ((20.5± 2.3) point,(23.4 ±2.1) point) after treatment than before treatment ((24.4±2.2) point,(24.5±2.1) point;F inner group =13.56,P＜0.01;F between group=12.46,P＜0.01;F across group=11.80,P＜0.01).The incidence rates of POCD scores in the epidural group were lower than those in the general anesthesia group.But the difference was not statistically significant (P＞0.05).Conclusion Both general anesthesia and epidural anesthesia impacts on cognitive function in elderly patients after orthopedic surgery,but the impact of general anesthesia is greater.