全麻与硬膜外麻醉对老年骨科手术患者术后认知功能的影响

刘兆杰

（陕西省富平县医院，陕西 渭南，711700）

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摘要：

目的 探讨全麻与硬膜外麻醉对老年骨科手术患者术后认知功能的影响。方法 选取我院老年骨科手术患者68例，按抽签顺序分为两组，各34例。对照组实施全身麻醉，观察组实施硬膜外麻醉，比较两组患者手术指标，麻醉前、后心率（HR）、平均动脉压（MAP）、认知功能评分情况。结果 两组患者低血压发生率及麻醉时间、出血量、输血量比较，差异不显著（P>0.05）；麻醉前及麻醉后各时间点，两组患者的HR、MAP水平比较，差异不显著（P>0.05）；麻醉后24 h，观察组患者认知功能评分明显高于对照组（P<0.05）。结论 与全身麻醉比较，硬膜外麻醉可减轻对老年骨科手术患者术后认知功能的影响，安全性较好。

关键词：全麻；硬膜外麻醉；骨科手术；认知功能

中图分类号：R614文献标志码：A文章编号：2096-1413(2017)18-0051-02

Effect of general anesthesia and epidural anesthesia on postoperative cognitive function in elderly patients undergoing orthopedic surgery
LIU Zhao-jie
(Fuping County Hospital, Weinan 711700, China)

ABSTRACT: Objective To investigate the effect of general anesthesia and epidural anesthesia on postoperative cognitive function in elderly patients with orthopedic surgery. Methods Sixty-eight elderly patients who received orthopedic surgery in our hospital were selected and divided into two groups according to the draw lots sequence, with 34 cases in each group. The control group received general anesthesia, and the observation group accepted epidural anesthesia. The operation indexes, HR and MAP before and after anesthesia, cognitive function scores of the two groups were compared. Results There were no significant differences on the incidence rate of hypotension, anesthesia time, bleeding volume and transfusion volume between the two groups (P>0.05). There were no significant differences on HR, MAP in each time point before and after anesthesia between the two groups (P>0.05). After 24 h anesthesia, the cognitive function score of the observation group was significantly higher than that of the control group (P<0.05). Conclusion Compared with general anesthesia, epidural anesthesia can reduce the effect on postoperative cognitive function in elderly patients with orthopedic surgery, which has high safety.

KEYWORDS: general anesthesia; epidural anesthesia; orthopedic surgery; cognitive function

参考文献：
[1] 程斌.不同麻醉方法对老年下肢骨折患者手术时vWF、FIB、TAT及D-二聚体的影响[J].现代中西医结合杂志,2016,25(11):1223-1225.


[2] 王言武.硬膜外麻醉下进行老年骨科手术时辅助小剂量轻比重腰麻的效果分析[J].医学综述,2015,21(24):4592-4594.
[3] 吉林,王曙,蔡国森,等.右美托咪定复合罗哌卡因硬膜外麻醉在老年患者骨科手术的应用[J].国际麻醉学与复苏杂志,2015,36(12):1071-1074.
[4] 周红梅,邓龙蛟,李水英,等.不同麻醉方法对下肢骨科手术老年患者术后认知功能障碍的影响[J].海南医学,2016,27(8):1324-1326.
[5] 李鹤,李传翔,宋冬梅,等.不同麻醉方式对老年骨科患者血流动力学及认知功能的影响[J].解放军医药杂志,2015,27(5):86-89.
[6] 喻金政.不同麻醉方式应用于老年骨科患者术后镇痛效果分析[J].检验医学与临床,2015,12(17):2584-2586.
[7] 靳丽敏.全身麻醉联合硬膜外麻醉对老年骨科患者术后短期认知功能的影响[J].中华老年医学杂志,2014,33(10):1072-1074.
[8] 雷学恒,吴涯雯,张双全,等.不同麻醉方式对骨科手术患者术后认知功能影响的荟萃分析[J].中国医药导报,2015,12(16):24-28.
[9] 瞿巍巍,王志云,黄培.硬膜外麻醉与静脉全身麻醉对老年骨科手 术术后精神状态及认知功能的影响[J].中国医师杂志,2016,18(3):453-455.
[10] 王小锐,李阳阳,郭玉娜,等.静脉辅助硬膜外麻醉在老年智力障碍髋部手术中的效果评价[J].中国医刊,2015,50(7):103-105.