全身麻醉和硬膜外麻醉对老年骨科手术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骨科手术患者术后短期认知功能的影响。方法：按随机数字方式将2010 年3 月至2013 年5 月收治的全麻骨科手术老年患者64 例分为两组，全身麻醉组（32 例）给予全身麻醉进行手术，硬膜外麻醉组（32 例）给予硬膜外麻醉进行手术，对比分析两组观察麻醉前后动脉血压与心率，睁眼、拔管及应答时间，术后6、12、24、72 h的MMSE 评分差异，并统计术后POCD的发生情况。结果：两组的年龄、体重、麻醉时间、受教育时间、出血量等一般临床资料均无明显差异（P＞0.05）；两组麻醉前、麻醉后术前、手术0.5h 及手术结束时动脉血压和心率差异均不显著（P＞0.05）；全身麻醉组的睁眼、拔管及应答时间分别为（30.3 ± 10. 5）min、（30.3 ± 7.8）min、（33.2 ± 9.6）min；膜外麻醉组的睁眼、拔管及应答时间分别为（30.6 ± 11.6）min、（30.1± 6.6）min、（34.3 ± 8.5）min，两组差异不显著（P＞0.05）；全身麻醉组麻醉前MMSE 评分为29.2 ± 1.5，而膜外麻醉组麻醉前MMSE 评分为29.1 ± 1.0，差异不显著（P＞0.05）；麻醉后，两组的MMSE 评分均出现先减少后恢复的变化，膜外麻醉组麻醉后24h 时的MMSE 评分28.7 ± 1.0 明显高于全身麻醉组的27.3 ± 0.8（t=5.491，P=0.000<0.05）；全身麻醉组麻醉后6h 和12hPOCD的发生率均明显高于膜外麻醉组的（P<0.05），而两组在麻醉后24h 开始POCD的发生率无明显差异（P＞0.05）。结论：全身麻醉对老年骨科手术患者术后短期认知功能的影响明显大于硬膜外麻醉。

Postoperative Short-termCognitive Function in ElderlyOrthopedic Patients Treating with General Anesthesiaand Epidural Anesthesia

Objective:To study the postoperative short-termcognitive function of the general anesthesia and epidural anesthesia inelderly patients with the orthopedic disease.Methods:64 elderly patients March 2010 to May 2013 with general anesthesia were dividedinto two groups by way of random Numbers, the general anesthesia group (32 cases) were given general anesthesia surgery, epiduralanesthesia group (32 cases) were given epidural anesthesia surgery, before and after anesthesia arterial blood pressure and heart rate, thetime of open, tube drawing and reply, the MMSE score of postoperative 6, 12, 24, 72 h were contrastively analysis.Results:two groupsof age, weight, anesthesia time, education time, blood loss, such as general clinical data had no obvious difference (P>0.05); beforeanesthesia, after anesthesia preoperative, 0.5 h and surgery at the end of the arterial blood pressure and heart rate of two groups hadsignificant difference (P>0.05); General anesthesia group open and tube drawing and response time, respectively were (30.3 ± 10.5) minand (30.3-7.8) min and (33.2 ± 9.6 min). Epidural anesthesia group open and tube drawing and response time (30.6± 11.6) min,respectively (30.1± 6.6) min and (34.3 ± 8.5) min, there were no significant differences between the two groups (P>0.05). Generalanesthesia group of MMSE score before anesthesia was 29.2 ± 1.5, anesthesia and epidural anesthesia group before the MMSE score was29.1± 1.0, with no significant difference(P>0.05). After anesthesia, the two groups after theMMSE score of all appear to reduce the changeof the recovery, 24 h after anesthesia epidural anesthesia group was significantly better than the MMSE score of 28.7± 1.0 of the generalanesthesia group 27.3 ± 0.8 (t=5.491, P=0.000 <0.05); 6 h after anesthesia and general anesthesia group 12 hpocd incidence weresignificantly higher than that of epidural anesthesia group (P<0.05), and two groups began to the incidence of POCD in 24 h afteranesthesia had no obvious difference (P>0.05).Conclusion:The effect of general anesthesia on postoperative short-term cognitivefunction in elderly patients with orthopaedic surgery significantly is greater than epidural anesthesia.