文语高

[摘要] 目的 分析不同麻醉方式对POCD发生的影响。 方法 将我院110例行麻醉手术患者根据麻醉方式分为观察组和对照组各55例，分别行硬膜外及全身麻醉，对比两组POCD发生情况。 结果 两组术后24hMMSE评分均显著降低，观察组术后24、72h MMSE评分高于对照组（P<0.05）。观察组术后24、72h POCD发生率低于对照组（P<0.05）。 结论 POCD的发生与麻醉方式关系密切，硬膜外麻醉POCD发生率较全身麻醉低，可根据个体情况选择麻醉方式，确保患者预后良好。

[关键词] 硬膜外麻醉；全身麻醉；POCD

[中图分类号] R614 [文献标识码] B [文章编号] 2095-0616（2015）17-155-03

Effect study of different anesthesia methods on the occurrence of POCD

WEN Yugao

Department of Anesthesia， Anshun People's Hospital， Guizhou， Anshun 561000， China

[Abstract] Objective To analyze the effect of different anesthesia methods on the occurrence of POCD. Methods 110 patients， who were received operation with anesthesia in our hospital were divided into observation group and control group according to different anesthesia methods， with 55 cases in each group. To compare the occurrence condation of POCD between the two groups who were respectively received operation with epidural anesthesia and general anesthesia. Results MMSE scores of 24h after operation of the two groups were significantly reduced， while which of 24h and 72h after operation in observation group were higher than which in control group（P<0.05）. The incidence of POCD of 24h and 72h after operation in observation group were lower than which in control group （P<0.05）. Conclusion The occurrence of POCD has close relationship with anesthesia methods which could be selected according to individual condation to ensure better prognosis of patients. The incidence of POCD of epidural anesthesia was lower than which of general anesthesia.

[Key words] Epidural anesthesia； General anesthesia； POCD

术后认知障碍（POCD）是老年患者术后常见并发症，表现为中枢神经系统症状，如精神错乱、人格改变、记忆损伤、认知障碍、技巧异常等[1]。其严重影响患者术后康复质量，生活质量。相关资料[2]显示老年患者全麻后POCD发生率高达40%，为降低术后POCD的发生，确保患者术后康复，本文以110例麻醉手术患者为研究对象，分析全身麻醉与硬膜外麻醉对术后POCD发生的影响，现报道如下。

1 资料与方法

1.1 一般资料

本组110例行麻醉手术患者均于2012年8月～2014年6月到我院就诊，按麻醉方式分为观察组和对照组各55例，观察组男31例，女24例；年龄50～80岁，平均（68.7±3.7）岁；四肢手术25例，腹部手术22例，头颈部手术8例；对照组男34例，女21例；年龄50～82岁，平均（66.8±4.0）岁；四肢手术23例，腹部手术23例，头颈部手术9例；两组手术方式、年龄、性别等资料经统计学处理，具有可比性（P>0.05）。

1.2 入选标准[3]

患者身体状况良好，可耐受手术；麻醉ASA分级I～Ⅲ级；排除行心脏手术者；排除精神障碍、人格分裂、意识不清、依从性患者；患者术前未服用安定或抗抑郁药物；无神经系统、心脏病史；无家族精神病史、严重器官疾病；心理测试愿意合作；无药物依赖史、帕金森症、酗酒、阿尔茨海默病等情况；患……