不同麻醉方式对老年膝关节置换术后认知功能的影响

目的探讨不同麻醉方式对老年患者膝关节置换术后认知功能的影响。方法选择ASA评分I～Ⅱ级择期膝关节置换手术的老年患者90例，随机分为硬膜外麻醉组（A组）、全身麻醉组（B组）和全麻复合硬膜外麻醉组（c组），通过MMSE评分比较三种不同麻醉方式对老年患者术后认知功能障碍发生率的影响。结果三组患者认识功能障碍的发生率术后1d分别为A组17％、B组33％、C组20％；术后7d分别为A组10％、B组20％，C组13％。术后1d三组比较，差异有统计学意义（P〈0．05）。A、C两组比较，差异无统计学意义（P〉0．05）；A、B两组比较和c、B两组比较，差异均有统计学意义（P〈0．05）。术后7d统计结果与术后1d一致。结论硬膜外麻醉、全麻复合硬膜外麻醉与全身麻醉组相比，能降低老年患者膝关节置换术后1d和术后7d认知障碍的发生率。

The Effect of Different Anesthetic Methods on Postoperative Cognitive Dysfunction in Elderly Patients Underwent Knee Replacement

Objective To investigate the effect of different anesthetic methods on postoperative cognitive dysfunction （ POCD ） after knee replacement in elderly. Methods All 90 ASA I - II elderly patients undergoing knee replacement in our hospital from December 2009 to October 2010 were randomly divided into three groups： epidural anesthesia alone（ group A ）, general anesthesia alone（ group B ） and epidural anesthesia combined with general anesthesia （ group C ）. MMSE test was applied in three groups before anesthesia and 1 day and 7 day after surgery to assess the cognitive function. Results On day 1, POCD occurred in 5/30 patients （ 17% ）in group A, in 10/30 patients （ 33% ）in group B and in 6/30 patients （ 20% ）in group C. On day 7,POCD occurred in 3/30 patients （ 10% ）in group A, in 6/30 patients （ 20% ） in group B and in 64/30 patients （ 13% ） in group C. On day 1, Statistically significant difference was found in three groups significant （ P 〈 0.05 ）, but no significant difference was found between group A and group C. Compared with group B, the incidence rate of POCD group A and group C was statistically significantly different （ P 〈 0.05 ）. The similar results were found after surgery 7 days. Conclusion Compared with general anesthesia alone, epidural anesthesia alone and epidural anesthesia combined with general anesthesia reduce the incidence rate of POCD after knee replacement 1 and 7days in elderly patients.