全麻及硬膜外麻醉对老年骨科患者短期认知功能的影响

周文全1，杨靖梅1 ，鱼进红2

（1.渭南市第二医院麻醉科，陕西 渭南，714000；2.高新医院，陕西 西安，710075）

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摘要：

目的 观察全身麻醉及硬膜外麻醉对老年骨科患者术后短期认知功能造成的影响。方法 将2014年2月至2015年2月住院的老年骨科患者240例根据麻醉方法的不同分为全身麻醉组和硬膜外麻醉组，每组120例，观察比较两组患者术后短期的认知功能情况，观察患者的苏醒时间、拔管时间和应答时间。结果 全身麻醉组麻醉前与麻醉后6、12、24 h 的 MMSE评分分别为（29.6±1.3）分和（25.5±0.9）、（25.9±0.8）、（26.4±0.9）分；硬膜外麻醉组麻醉前与麻醉后6、12、24 h的 MMSE 评分分别是（29.3 ± 1.4）分和（25. 7±1.2）、（26. 5± 1. 5）、（29.0±1.6）分；两组患者麻醉前MMSE评分不存在统计学差异（P>0.05）；全身麻醉组麻醉后6、12、24 h 的MMSE评分明显低于本组麻醉前（P<0.01）；硬膜外麻醉组麻醉后 6 h、12 h的MMSE评分明显低于本组麻醉前（P<0.01）；全身麻醉组麻醉后12 h、24 h 的MMSE评分明显低于硬膜外麻醉组（P<0.01）。两组患者术后12 h、24 h发生认知障碍的病例数存在统计学差异（P<0.05）。结论 老年骨科患者手术采取 全身麻醉、硬膜外麻醉后短期均可出现认知功能障碍，全身麻醉患者更为明显，条件允许时临床应使用硬膜外麻醉法。

关键词：老年；骨科患者；麻醉；短期认知功能

中图分类号：R614文献标志码：A文章编号：2096-1413(2016)27-0015-02

The impact observation of general anesthesia and epidural anesthesia on short-term cognitive function in elderly patients
ZHOU Wen-quan 1, YANG Jing-mei 1, YU Jin-hong 2
(1. Department of Anesthesiology, the Second Hospital of Weinan, Weinan 714000; 2. Gaoxin Hospital, Xi`an 710075, China)


ABSTRACT: Objective To observe the impact of general anesthesia and epidural anesthesia on short -term cognitive functionin elderly orthopaedic patients. Methods Two hundred and forty cases of elderly orthopedic patients were selected and divided into general anesthesia group (120 cases) and epidural anesthesia group (120 cases) according to the different methods of anesthesia. The short-term cognitive function after operation, awakening time, extubation time and response time were compared between the two groups. Results The MMSE scores of the general anesthesia group were (29.6±1.3) before anesthesia, (25.5±0.9), (25.9±0.8) and (26.4±0.9) respectively at 6, 12 and 24 h after anesthesia; the MMSE scores of the epidural anesthesia group were (29.3±1.4) before anesthesia, (25.7±1.2), (26.5±1.5) and (29.0±1.6) respectively at 6, 12 and 24 h after anesthesia. There was no statistical difference in MMSE scores before anesthesia between the two groups (P>0.05). The MMSE scores of the general anesthesia group at 6, 12 and 24 h after anesthesia were significantly lower than those before anesthesia (P<0.01), and the MMSE scores of the epidural anesthesia group at 6 and 12 h after anesthesia were significantly lower than those before anesthesia (P<0.01). The MMSE scores of the general anesthesia group at 12 and 24 h after anesthesia were significantly lower than those in the epidural anesthesia group (P<0.01). There were statistically significant differences in cognitive impairment between the two groups at 12 and 24 h after operation (P<0.05). Conclusion Elderly patients with orthopaedic surgery after general anesthesia and epidural anesthesia would appear cognitive dysfunction in the short -term, especially for patients with general anesthesia. Clinic should make the use of epidural anesthesia when conditions permit.
KEYWORDS: elder patients; orthopaedic patients; anesthesia; short-term cognitive function

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