全身麻醉与硬膜外麻醉对老年患者术后认知的影响(1)
[摘要] 目的 探析硬膜外麻醉與全身麻醉两种不同的麻醉方式对老年患者术后认知造成的影响。 方法 此次58例研究对象为方便选取自2016年10月—2017年10月间在该院进行手术治疗的患者，对所选对象进行随机分组，两组患者分别应用不同的麻醉方式，对比硬麻组患者与全麻组患者的术中出血量、手术时间，分别于手术进行前、麻醉后6、12 h以及24 h以及72 h评定患者的认知功能。对比两组患者麻醉前、术前、手术进行过程中以及术后心率HR、BP。结果 硬麻组术中出血量为(164.5±36.8)mL，手术时间为(114.3±19.7)min，全麻组分别为(169.7±39.9)mL、(118.9±17.4)min，两组患者术中出血量差异无统计学意义(t=0.984 3，P=0.072 4)，两组手术时间差异无统计学意义(t=0.988 2，P=0.063 7)。麻醉后24 h硬麻组MMSE评分为(29.6±0.5)分，全麻组评分为(26.9±0.4)分，全麻组患者MMSE评分麻醉前与麻醉后6 h对比差异有统计学意义(t=9.391 8，P=0.035 2)、麻醉前与麻醉后12小时差异有统计学意义(t=11.062 3，P=0.026 7)、麻醉前与麻醉后24 h对比差异有统计学意义(t=7.073 8，P=0.018 6)，硬麻组患者MMSE评分麻醉前与麻醉后6 h对比差异有统计学意义(t=12.631 3，P=0.025 8)、麻醉前与麻醉后12 h差异有统计学意义(t=10.029 3，P=0.015 4)、麻醉前与麻醉后24 h对比差异有统计学意义(t=8.032 3，P=0.024 9)。两组麻醉后24 h差异有统计学意义(t=7.0908，P=0.0237)。 结论 两种不同的麻醉方式均会使患者产生一定程度的术后认知功能障碍，采取硬膜外麻醉的患者术后24 h认知功能受影响程度明显低于进行全身麻醉的患者。
[关键词] 全身麻醉；硬膜外麻醉；术后认知
[中图分类号] R614 [文献标识码] A [文章编号] 1674-0742(2018)11(b)-0028-03
Effect of General Anesthesia and Epidural Anesthesia on the Postoperative Cognition of Senile Patients
HU Liang-yan， LI Zhao-biao， LI Hui-xian
Department of Anesthesia， Wenshan People’s Hospital， Wenshan， Yunnan Province， 663000 China
[Abstract] Objective To study the effect of general anesthesia and epidural anesthesia on the postoperative cognition of senile patients. Methods 58 cases of patients in our hospital treated with surgery from October 2016 to October 2017 were convenient selected and randomly divided into two groups， the two groups applied different anesthesia ways， and the intraoperative bleeding amount， operation time of the two groups were compared， and the cognitive functions was evaluated before operation， in 6， 12， 24 h and 72 h after anesthesia were evaluated， and the HR and BP before， in and after operation and before anesthesia were compared between the two groups. Results The intraoperative bleeding amount and operation time in the epidural anesthesia group and in the general anesthesia group were respectively(164.5±36.8)mL，(114.3±19.7) min and (169.7±39.9)mL、(118.9±17.4) min， and the difference in the intraoperative bleeding amount between the two groups was not statistically significant(t=0.984 3， P=0.072 4)， and the difference in the operation time between the two groups was not statistically significant(t=0.988 2， P=0.063 7)， and the 24 h MMSE score after anesthesia in the epidural anesthesia group and in the general anesthesia group was respectively (29.6±0.5)points and ( 26.9±0.4)points， and the differences in the MMSE scores before anesthesia and in 6h after anesthesia in the general anesthesia group were statistically significant(t=9.391 8， P=0.035 2)， and the differences before anesthesia and in 12 h after anesthesia was statistically significant (t=11.062 3， P=0.026 7)， and the difference before anesthesia and in 24 h after anesthesia was statistically significant (t=7.073 8， P=0.018 6)， and the differences in the MMSE scores before anesthesia and in 6 h after anesthesia in the epidural anesthesia group were statistical(t=12.631 3， P=0.025 8) ， and the difference before anesthesia and in 12 h after anesthesia between the two groups was statistically significant(t=10.029 3，P=0.015 4) ， and the difference before anesthesia and in 24 h after anesthesia was statically significant (t=8.032 3， P=0.024 9)， and the difference in 24 h after anesthesia between the two groups was obvious ( t=7.090 8， P=0.023 7). Conclusion The two different anesthesia ways can produce a certain postoperative cognitive dysfunction to patients， and the effect on the 24 h cognitive function after surgery of patients with epidural anesthesia is obviously lower than that of patients with general anesthesia., 百拇医药(虎良艳 李朝标 李慧娴)
[关键词] 全身麻醉；硬膜外麻醉；术后认知
[中图分类号] R614 [文献标识码] A [文章编号] 1674-0742(2018)11(b)-0028-03
Effect of General Anesthesia and Epidural Anesthesia on the Postoperative Cognition of Senile Patients
HU Liang-yan， LI Zhao-biao， LI Hui-xian
Department of Anesthesia， Wenshan People’s Hospital， Wenshan， Yunnan Province， 663000 China
[Abstract] Objective To study the effect of general anesthesia and epidural anesthesia on the postoperative cognition of senile patients. Methods 58 cases of patients in our hospital treated with surgery from October 2016 to October 2017 were convenient selected and randomly divided into two groups， the two groups applied different anesthesia ways， and the intraoperative bleeding amount， operation time of the two groups were compared， and the cognitive functions was evaluated before operation， in 6， 12， 24 h and 72 h after anesthesia were evaluated， and the HR and BP before， in and after operation and before anesthesia were compared between the two groups. Results The intraoperative bleeding amount and operation time in the epidural anesthesia group and in the general anesthesia group were respectively(164.5±36.8)mL，(114.3±19.7) min and (169.7±39.9)mL、(118.9±17.4) min， and the difference in the intraoperative bleeding amount between the two groups was not statistically significant(t=0.984 3， P=0.072 4)， and the difference in the operation time between the two groups was not statistically significant(t=0.988 2， P=0.063 7)， and the 24 h MMSE score after anesthesia in the epidural anesthesia group and in the general anesthesia group was respectively (29.6±0.5)points and ( 26.9±0.4)points， and the differences in the MMSE scores before anesthesia and in 6h after anesthesia in the general anesthesia group were statistically significant(t=9.391 8， P=0.035 2)， and the differences before anesthesia and in 12 h after anesthesia was statistically significant (t=11.062 3， P=0.026 7)， and the difference before anesthesia and in 24 h after anesthesia was statistically significant (t=7.073 8， P=0.018 6)， and the differences in the MMSE scores before anesthesia and in 6 h after anesthesia in the epidural anesthesia group were statistical(t=12.631 3， P=0.025 8) ， and the difference before anesthesia and in 12 h after anesthesia between the two groups was statistically significant(t=10.029 3，P=0.015 4) ， and the difference before anesthesia and in 24 h after anesthesia was statically significant (t=8.032 3， P=0.024 9)， and the difference in 24 h after anesthesia between the two groups was obvious ( t=7.090 8， P=0.023 7). Conclusion The two different anesthesia ways can produce a certain postoperative cognitive dysfunction to patients， and the effect on the 24 h cognitive function after surgery of patients with epidural anesthesia is obviously lower than that of patients with general anesthesia., 百拇医药(虎良艳 李朝标 李慧娴)