酗酒老年患者全麻术后早期认知功能的改变

摘要

目的：通过临床对照试验,评价酗酒老年患者下腹部或四肢手术全麻术后早期认知功能的改变。方法选择择期行下腹部或四肢手术的患者60例,均为男性,年龄65~80岁,ASA Ⅰ或Ⅱ级,符合酗酒史条件的患者30例,作为酗酒组(A 组)；根据病种、术式选择匹配的无酗酒史患者30例,作为对照组(C 组),所有患者均接受全凭静脉麻醉。记录患者术前、术中一般情况及术后7d内主要并发症的发生情况,采用简易精神状态量表(MMSE)测定两组患者术前1 d、术后1、7d的认知功能。结果两组麻醉时间、拔管时间、主要麻醉药用量、血管活性药用量、术中出血量等差异均无统计学意义。与术前1d比较,术后1、7d两组 MMSE 评分均明显降低(P <0.05)；与术后1d比较,术后7dA 组 MMSE 评分明显升高(P <0.05)；术后1、7dA 组 MMSE 评分明显低于 C 组(P <0.05)。术后1、7dA 组 POCD 发生率明显高于 C 组(P <0.05)。术后7d内 A 组主要并发症的发生率均高于 C 组,但差异无统计学意义。结论酗酒可增加老年患者全麻术后早期认知功能障碍的发生率。%Objective To evaluate the effect of alcoholism history on the elderly patients’early cognitive function after lower abdominal or limbs surgery under general anesthesia through controlled clinical trials.Methods Sixty male patients aged 65-80 years of ASA grade Ⅰ or Ⅱ were selected un-dergoing lower abdominal or limbs surgery,30 cases with alcoholism history as alcohol group(group A),30 cases without alcoholism experience as control group (group C).All patients were anesthe-tized intravenously.The general data before and during operation,and the postoperative complications were recorded.The mini mental state examination(MMSE)was performed to assess the cognitive function 1d before and 1,7 d after surgery,then post-operative cognitive dysfunction(POCD)was compared between the two groups through analysis of the MMSE score.Results The MMSE score of 1,7 d after surgery in two groups was significantly lower than that of the preoperative(P < 0.05 ). Compared with the score 1 d after surgery,the score of 7 d post-operation was significantly higher in group A (P <0.05).The postoperative score in group A were significantly lower than that in group C 1,7 d after surgery (P <0.05).The incidence of POCD in group A were higher than that in group C 1,7 d after surgery (P <0.05 ).Conclusion Alcoholism history can increase the incidence of early cognitive dysfunction in elderly patients after general anesthesia.