不同麻醉和镇痛方法对老年患者非心脏手术术后早期认知功能的影响

摘要

Objective:To explore the effect of different methods of anesthesia and analgesia for non-cardiac surgery on early postoperative cognitive function of elderly patients,and provide a reference for clinical practice.Method:240 elderly patients who were treated with non-cardiac surgery from June 2012 to December 2013 in our hospital were selected,they were randomly divided into the general anesthesia analgesia group and the combined spinal epidural anesthesia epidural analgesia group,120 cases in each group.The pain levels and neurological function of postoperative within 36 h and the cognitive dysfunction preoperative and postoperative in 7 d between the two groups were observed. Result:The ECG,BP,HR,SpO2 of two groups were in the normal range in operation,no significant difference. Postoperative 36 h,conducted VAS score every 12 h,the results showed that the general anesthesia analgesia group were significantly better than the combined spinal epidural anesthesia epidural analgesia group(P<0.05).The MMSE scores in combined spinal epidural anesthesia epidural analgesia group at 12,24,36 h were significantly higher than those in general anesthesia analgesia group(P<0.05).The number of patients in two groups preoperative cognitive impairment was 0 postoperative.At 7 d after operation,the incidence of cognitive dysfunction of combined spinal epidural anesthesia epidural analgesia group was significantly lower than that in general anesthesia analgesia group(P<0.05).Conclusion:The pathogenesis of cognitive impairment in elderly people after surgery is unclear,more in-depth study of the effects of different anesthetics and different methods of anesthesia and analgesia on postoperative mental and neurological aspects of the elderly is necessary to guide the clinical rational drug use,and reduce the incidence rate of adverse reaction after operation.%目的：探究不同麻醉和镇痛方法对老年患者非心脏手术术后早期认知功能的影响，为临床提供参考。方法：选取2012年6月-2013年12月来本院接受非心脏手术治疗的240例老年患者，按照随机数字表法将其分为全身麻醉静脉镇痛组和腰硬联合麻醉硬膜外镇痛组各120例，观察两组患者术后36 h内的疼痛程度、神经精神功能以及术前、术后7 d认知功能障碍的发生率。结果：两组术中的ECG、BP、HR、SpO2均在正常范围，无显著差异；术后36 h内，每隔12 h进行1次的VAS评分结果显示，全身麻醉静脉镇痛组的镇痛效果均明显优于腰硬联合麻醉硬膜外镇痛组（P<0.05）；通过两组手术期MMSE评分比较，腰硬联合麻醉硬膜外镇痛组术后12、24、36 h的MMSE评分均明显高于全身麻醉静脉镇痛组（P<0.05）；两组术前发生认知功能障碍的患者数量均为0，而腰硬联合麻醉硬膜外镇痛组术后7 d认知功能障碍的发生率明显低于全身麻醉静脉镇痛组（P<0.05）。结论：老年人术后认知障碍的发病机理尚不明确，还需更深入的研究不同麻药、不同麻醉方法和镇痛方法对老年人术后精神和神经方面的影响，以指导临床合理用药，减少术后不良反应的发生率。