王东

[摘要] 目的 研究全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的影响。 方法 选取2013年7月～2014年7月我院收治的86例老年骨科手术患者，根据随机分组原则将其分为甲组（43例）及乙组（43例），甲组采用全身麻醉，乙组采用硬膜外麻醉，分析两组患者术后认知情况。 结果 两组患者麻醉前、麻醉后术前、手术30 min、手术操作时、手术完成时等不同时刻心率和动脉血压比较，差异无统计学意义（P>0.05）；甲组患者苏醒时间、语言恢复时间分别为（11.61±3.43）、（14.53±5.01）min，较乙组的（3.74±2.32）、（6.22±3.12）min更长，麻醉药用量为（226.31±9.90）ml，多于乙组的（201.23±7.12）ml，差异有统计学意义（P<0.05）；麻醉前，两组患者简易精神状态检查量表（MMSE）评分比较，差异无统计学意义（P>0.05），麻醉后6、12、24、72 h，乙组患者MMSE评分低于甲组（P<0.05）；术后6、12、24、72 h，甲组患者认知功能障碍发生率均高于乙组（P<0.05）；甲组患者临床治疗满意率为72.09%，低于乙组的93.02%（P<0.01）。 结论 在老年患者行骨科手术时，全身麻醉和硬膜外麻醉方法对患者心率、动脉血压的影响较小，硬膜外麻醉对术后短期认知功能影响较小，可缩短苏醒时间，降低术后认知功能障碍的发生率，确保手术治疗效果，提高患者的生活质量，值得临床推广应用。

[关键词] 老年患者；骨科手术；硬膜外麻醉；全身麻醉；认知功能

[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0112-04

Impact of general anesthesia and epidural anesthesia on postoperative short-term cognitive function of elderly patients with orthopaedic

WANG Dong

Department of Anesthesiology，Dalian Third People′s Hospital in Liaoning Province，Dalian 116000，China

[Abstract] Objective To study and analyze the impact of general anesthesia and epidural anesthesia on postoperative short-term cognitive function of elderly patients with orthopaedic. Methods 86 elderly patients with orthopaedic from June 2013 to June 2014 were selected and were randomly divided into Group A （n=43） and Group B （n=43）.Patients in Group A were used general anesthesia.Patients in Group B were used epidural anesthesia.Postoperative cognitive function in two groups was analyzed. Results Heart rate and arterial blood pressure in two groups at pre-anesthesia，postanesthesia but before operation，half an hour after operation，during operation and end of operation had no obvious statistical significance （P>0.05）；The awakening time and language recovery time in Group A were respectively （11.61±3.43） min and （14.53±5.01） min，which was respectively longer than of （3.74±2.32） min and （6.22±3.12） min in Group B；the dosage of anesthetic was （226.31±9.90） ml in Group A，which was more than that of （201.23±7.12） ml in Group B，and the difference was statistical significance （P<0.05）；before anesthesia，the MMSE score between two groups had no obvious difference （P>0.05），but the MMSE score in Group B was lower than Group A at 6，12，24，72 h after anesthesia （P<0.05）；the incidence rate of cognitive dysfunction in Group A were higher than Group B at 6，12，24，72 h after anesthesia （P<0.05）；the clinical treatment satisfaction rate in Group A was 72.09%，which was lower than that of 93.02% in Group B （P<0.01）. Conclusion During orthopaedic surgery in elderly patients，general anesthesia and epidural anesthesia have little impact on patients′ heart rate and arterial blood pressure；epidural anesthesia has little impact on postoperative short-term cognitive function and can speed up the awakening time，reduce the incidence rate of postoperative short-term cognitive function，ensure the operation treatment effects and enhance life quality of patients.It is worth to popularize in clinic.

[Key words] Elderly patients；Orthopaedic surgery；Epidural anesthesia；General anesthesia；Cognitive function

随着我国人口老龄化进程的不断加快，老年身体功能下降，各组织器官处于衰退状态，肢体活动能力降低，易发生跌倒等意外，因骨骼系统退化，需要接受手术治疗的老年骨科患者越来越多。麻醉是手术中常见的操作方法，因老年患者代谢较慢，且伴有诸多基础疾病，如高血压、糖尿病等，麻醉易对中枢神经系统造成一定的损伤，引起患者认知功能障碍，降低患者的生活质量。术后认知功能障碍（POCD）是术后常见的中枢神经系统并发症之一[1]，多发于老年患者，可表现为记忆受损、认知能力下降、精神混乱、焦虑等，影响手术的疗效和预后。老年患者器官组织处于衰退状态，多种因素引起中枢神经递质系统紊乱，导致POCD发生。POCD持续时间可长可短，不仅会影响治疗效果，还会给患者、家庭带来较大的负担[2]。为减……