全身麻醉和硬膜外麻醉对老年患者术后短期认知功能的影响

目的：探讨全身麻醉和硬膜外麻醉对老年患者术后短期认知功能的影响。方法：选择拟行外科手术治疗老年患者120例,随机分为观察组和对照组,每组60例。观察组患者采取硬膜外麻醉方法,对照组采取全身麻醉方法。记录两组患者麻醉前、术后6h、24h、72h和5d的蒙特利尔认知评估量表（MoCA）评分,并比较两组患者术后认知功能障碍（POCD）发生率。结果：两组患者术后6h、24h和72h的MoCA评分比较差异均有统计学意义（P〈0.05）,术后5d的MoCA评分比较差异无统计学意义（P〉0.05）;观察组患者术后6h和24h的MoCA评分均低于麻醉前,差异有统计学意义（P〈0.05）,术后72h和5d的MoCA评分与麻醉前比较差异无统计学意义（P〉0.05）;对照组患者术后6h、24h和72h的MoCA评分均低于麻醉前,差异有统计学意义（P〈0.05）,术后5d的MoCA评分与麻醉前比较差异无统计学意义（P〉0.05）;两组患者术后6h、24h和72h的POCD发生率比较差异均有统计学意义（P〈0.05）,术后5d的POCD发生率比较差异无统计学意义（P〉0.05）。结论：硬膜外麻醉对老年患者术后短期认知功能影响较全身麻醉轻,POCD发生率低,值得临床进一步研究。

The Effects of General Anesthesia and Epidural Anesthesia on Postoperative Cognitive Function in Elderly Patients

Objective ：To explore the effects of general anesthesia and epidural anesthesia on postoperative cognitive function in elderly patients .Methods ：120 elderly patients with surgical operation were randomly divided into the observation group and control group ,which contained 60 cases respectively .The method of anesthesia in the observation group was epidural anesthesia ,while general anesthesia was used in the control group .The Montreal Cognitive Assessment （MoCA） scores were recorded in the two groups before anesthesia ,at 6h ,24h ,72h and 5d after operation . Additionally ,the rates of postoperative cognitive dysfunction （POCD） were compared between the two groups .Results ：There were significant differences in MoCA scores between the two groups at 6h ,24h and 72h after operation （all P〈0 .05） .However ,no significant differences were found in MoCA scores at 5d after operation between the two groups （P〉0 .05） .In the observation group ,the MoCA scores at 6h and 24h after operation were all significantly lower than those before anesthesia （all P〈0 .05） ,and there were not significant differences in MoCA scores at 72h and 5d after operation compared to those before anesthesia respectively （all P〉0 .05） .In the control group ,the MoCA scores at 6h ,24h and 72h after operation were all significantly lower than those before anesthesia （all P〈0 .05） ,and there were not significant differences in MoCA scores at 5d after operation compared to those before anesthesia respectively （P〉0 .05） .There were significant differences in the rates of POCD between the two groups at 6h ,24h and 72h after operation （all P〈0 .05） .However ,no significant differences were found in rates of POCD at 5d after operation between the two groups （P〉0 .05） .Conclusion：The effect of epidural anesthesia on postoperative cognitive function in elderly patients is less ,and the rate of POCD is lower compared with general anesthesia ,consequently being worthy of further investigation