冯念海　张玉柱

[摘要] 目的 探讨对老年骨科手术患者分别采用全麻和硬膜外麻醉后对其认知功能的影响。 方法 选择本院2015年3月～2016年3月老年骨科手术患者60例，随机分为A组和B组，每组各30例。B组采取全身麻醉，A组采取硬膜外麻醉。观察两组术前术后MMSE评分的变化情况，对比分析两组患者术后认知功能障碍的发生率。结果 A组术前的MMES评分为（28.90±3.24）分，B组术前的MMES评分为（29.10±4.15）分，两组比较，差异无统计学意义（P>0.05）；A组术后6 h、术后12 h、术后24 h的MMES评分均显著高于B组，差异有统计学意义（P<0.05）；A组术后6 h、术后12 h的认知功能障碍发生率分别为3.3%、3.3%，均显著低于B组，差异有统计学意义（P<0.05），但A组与B组术后24 h的认知功能障碍发生率比较，差异无统计学意义（P>0.05）。 结论 老年骨科手术患者采用全麻和硬膜外麻醉效果均较好，但硬膜外麻醉有利于提高患者的认知功能、降低认知功能障碍的发生率。

[关键词] 老年；骨科手术；全麻；硬膜外麻醉；MMES评分；认知功能障碍

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2017）16-0103-03

[Abstract] Objective To investigate the effect of general anesthesia and epidural anesthesia on cognitive function in elderly patients undergoing orthopedics surgery. Methods A total of 60 cases of elderly patients in department of orthopedics from March 2015 to March 2016 in our hospital were randomly divided into group A and group B， each group of 30 cases. Group B received general anesthesia， group A received epidural anesthesia. The changes of MMSE score before and after operation in two groups were observed， and the incidence of postoperative cognitive dysfunction was compared between the two groups. Results In group A， preoperative MMES score was （28.90±3.24） points， the group B preoperative MMES score was（29.10±4.15） points， there was no statistically significant difference between the two groups （P>0.05）； MMES scores of Group A at 6 h， 12 h， 24 h after surgery were significantly higher than those of the group B， the difference was statistically significant （P<0.05）； The incidence of cognitive dysfunction of group A at 6 h and 12 h after operation was 3.3% and 3.3% respectively， significantly lower than those of the group B， the difference was statistically significant（P<0.05）， but the incidence of cognitive dysfunction of group A and group B at 24 h after operation had no statistically significant difference（P>0.05）. Conclusion The conclusion of the elderly patients in department of orthopedics surgery by general anesthesia and epidural anesthesia is better， but the epidural anesthesia can improve the cognitive function of patients， reduce the incidence of cognitive dysfunction.

[Key words] Aged； Orthopedics surgery； General anesthesia； Epidural anesthesia； MMES score； Cognitive dysfunction

老年患者行骨科手術后易出现学习记忆、定向、精神、运动、行为等认知功能方面的紊乱[1]。目前研究认为，术后认知功能障碍与麻醉方法的选择密切相关[2]。全身麻醉和硬膜外麻醉为骨科手术常用的麻醉方法，研究发现麻醉后大脑血流减少，处于异常状态，可损伤中枢神经元和神经系统，严重者甚至造成永久性伤害；老年患者脑部功能退化，因此，可能导致认知功能出现障碍[3-4]。本研究旨在探讨全麻和硬膜外麻醉对老年骨科手术患者术后短期认知功能的影响，现报道如下。

1 资料与方法

1.1 一般资料

选择我院2015年3月～2016年3月老年骨科手术的患者60例，均为择期手术，年龄60岁及以上，患者或家属均对本研究知情同意，并签署知情同意书，排除合并严重的心、肝、肾功能障碍及凝血功能障碍者。美……