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

摘要

Objective To evaluate the influence of different anesthesia methods on the postoperative cognitive function in elderly patients who underwent lower extremity orthopaedic surgery. Methods From April 2013 to April 2015, 100 elderly patients (older than 65) in our hospital were randomly divided into the spinal-epidural anesthesia group (Ⅰ, n=50) and total intravenous anesthesia group (Ⅱ, n=50). The cognitive function was evaluated on 1 day be-fore operation and 1 day, 7 days after operation with the montreal cognitive assessment (MoCA). Results MoCA score of 1 day before operation in groupⅠandⅡwas [(26.60±0.75) and (26.54±0.72)]. MoCA score of 1 day and 7 days af-ter operation in groupⅠandⅡwas respectively [(22.61 ± 1.60) and (20.11 ± 1.96)] and [(11 ± 0.92) and (22.90 ± 1.64)] , which were lower than those on 1 day before operation (P<0.01, P<0.05). The MoCA scores were higher on 1 day and 7 days after operation in the groupⅠthan those at the same time in the groupⅡ(P<0.05). The incidences of postoperative cognitive dysfunction (POCD) on 1 day and 7 days after operation were 20%(10/50) and 10%(5/50) in the groupⅠ, 40%(20/50) and 26%(13/50) in the groupⅡ. The incidence of POCD was lower on 1 day and 7 days after operation in the groupⅠthan that at the same time in the groupⅡ(P<0.05). Conclusion The spinal-epidural anesthesia has smaller effect on the cognitive function in elderly patients who underwent lower extremity orthopaedic surgery, and the inci-dence of postoperative cognitive dysfunction is less than other anesthesia methods.%目的 评估不同麻醉方法对老年下肢骨科手术患者术后认知功能的影响.方法 选取我院2013年4月至2015年4月年龄≥65岁择期下肢骨科手术的老年患者100例,随机、双盲分为腰硬联合麻醉组(Ⅰ组)50例,全凭静脉麻醉组(Ⅱ组)50例.分别于术前1 d及术后1 d、7 d采用蒙特利尔认知评估表(MoCA)测评认知功能.结果 Ⅰ组、Ⅱ组术后1 d的MoCA评分[(22.61±1.60)分、(20.11±1.96)分]和术后7 d评分[(25.11±0.92)分、(22.90±1.64)分]均低于术前1 d的评分[(26.60±0.75)分、(26.54±0.72)分],差异均有统计学意义(P<0.01或0.05);Ⅰ组术后1 d、7 d评分明显高于相同时间点Ⅱ组的评分,差异均有统计学意义(P<0.05);术后1 d和7 d的认知功能障碍(POCD)发生率Ⅰ组分别为20%(10/50)、10%(5/50),Ⅱ组分别为40%(20/50)、26%(13/50);Ⅰ组术后1 d、7 d术后POCD发生率均低于相同时间点Ⅱ组,差异均有统计学意义(P<0.05).结论 老年下肢骨科手术患者采用腰硬联合麻醉对术后认知功能影响较小,POCD发生率较低.