全身麻醉与硬膜外麻醉对老年全髋关节置换术患者术后认知功能的影响研究

摘要

Objective:To investigate the influence of general anesthesia and epidural anesthesia on cognitive function of elderly patients after total hip replacement. Methods:Sixty - eight cases of elderly patients undergoing total hip replacement were randomly divided into two groups,the control group was treated by tracheal intubation general anesthesia,the observation group was treated by continuous epidural anesthesia. To evaluate the cognitive function before and after anesthesia using mini mental state examination scale(MMSE). Results:The MMSE scores of patients in the control group after anesthesia,6 h,12 h and 24 h were significantly lower than before the induction of anesthesia,with statistically significant difference(P <0. 05),and the observation group after anesthesia,6 h,12 h and24 h MMSE were lower than those before induction of anesthesia,but the difference was not statistically significant(P >0. 05),compared with the control group with significant difference(P <0. 05). Af-ter 6 h,12 h and 24 h,the incidence of postoperative cognitive dysfunction(POCD)of observation group were 14. 71% ,8. 82%and 5. 88% ,were significantly lower than the control group and the difference had statistical significance(P <0. 05). Conclusion:The effect of epidural anesthesia on POCD in elderly patients with total hip replacement is significantly reduced compared with general anesthesia,has better clinical application value,is suitable for popularization and application.%目的：探讨全身麻醉和硬膜外麻醉对老年全髋关节置换术患者术后认知功能的影响。方法：选择68例拟行全髋关节置换术的老年患者，并采用随机数字表法将其分为两组，其中对照组采取气管插管全身麻醉，观察组采取连续硬膜外麻醉，用简易精神状况检查量表（MMSE）评估患者麻醉诱导前及麻醉后不同时间点的认知功能情况。结果：对照组患者麻醉后6 h，12 h 和24 h 时 MMSE 评分均显著低于麻醉诱导前，差异有统计学意义（P ＜0.05）；观察组麻醉后6 h，12 h 和24 h 时 MMSE 评分低于麻醉诱导前，但差异无统计学意义（P ＞0.05）。而与对照组比较，差异有统计学意义（P ＜0.05）。观察组患者术后6 h，12 h 和24 h 时术后认知功能障碍（POCD）发生率分别为14.71％，8.82％和5.88％，均较对照组显著降低，差异有统计学意义（ P ＜0.05）。结论：硬膜外麻醉对老年全髋关节置换术患者POCD 影响较全身麻醉明显减轻，具有较好的临床应用价值。