腰硬联合麻醉和全麻对老年患者术后早期认知功能影响的对比研究

目的:探讨腰硬联合麻醉和全身麻醉对老年患者术后早期认知功能影响。方法:随机选取在我院住院的160例ASAⅠ～Ⅱ级择期行非心脏手术的老年患者,按照随机对照的原则分为全身麻醉组和腰硬联合麻醉组,采用MMSE量表(简易智能状态检查法)对比评估两组患者术后3h、6h、1d及3d的认知功能障碍。结果:术后3h、6h、1d各组SE评分与麻醉前均有不同程度的降低,比较差异均具有统计学意义(P<0.05),术后3d各组MMSE评分与麻醉前比较,差异均无统计学意义(P>0.05);术后3h、6h全身麻醉级的SE评分明显低于腰硬联合麻醉组,比较差异均具有统计学意义(P<0.05);术后3h全身麻醉组和腰硬联合麻醉组认知功能障碍发生率分别为48.75%、32.50%,术后6h全身麻醉组和硬膜外麻醉组认知功能障碍发生率分别为18.75%、7.5%,比较差异均具有统计学意义(P<0.05)。结论:全身麻醉组患者术后早期MMSE评分下降较腰硬联合麻醉组患者明显,术后认知功能障碍的发生率明显高于腰硬联合麻醉组。术后认知功能障碍在术后1～3d基本能恢复正常。

Comparison Research on Impacts of Combined Spinal Epidural Anesthesia and General Anesthesia on Early Cognitive Function of Aged Patients

Objective:The impacts of Combined Spinal Epidural Anesthesia(CSEA) and general anesthesia on the aged patients after surgery were discussed.Methods:160 ASA LevelⅠand LevelⅡaged patients hospitalized in our hospital who would receive non-heart surgeries at stated time were selected randomly.They were grouped into general anesthesia group and CSEA group according to random comparison principle.MMSE scale (mini-mental state examination) was adopted to compare and evaluate the cognitive functional disorder of the patients of the two groups after surgery in 3 hours,6 hours,1 day and 3 days.Results:Compared with house before anesthesia,the MMSE ratings of two groups in 3 hours,6 hours and 1 day after surgery fell to different extents.All comparative differences were of statistical significance(P<0.05),while all differences were of no statistical significance(P>0.05) according to the MMSE ratings of two groups in 3 days after surgery compared with those before anesthesia;MMSE rating of general anesthesia in 3 hours and 6 hours after surgery was obviously lower than that of CSEA group.All comparative differences were of statistical significance(P<0.05);the incidences of the cognitive functional disorder of general anesthesia group and CSEA group were 48.75%and 32.50% respectively in 3 hours and 6 hours after surgery.The incidences of the cognitive functional disorder of general anesthesia group and CSEA group were 18.75%and 7.5%respectively.All comparative differences were of statistical significance(P<0.05).Conclusions:The reduction of MMSE rating of patients in general anesthesia group in the early stage after surgery was more obvious than that of patients in CSEA group.while the incidence of cognitive functional disorder of patients in general anesthesia group after surgery was obviously higher than that of CSEA group.The post-surgery cognitive functional disorder can be basically recovered to normal status in 1 day to 4 days after surgery.