邓波

【摘 要】：目的 对比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 以2017年1月-12月为病例选取时间，纳入94例骨科手术老年患者，以入院顺序为依据，分为参照组、研究组，各47例，分别予以全身麻醉、硬膜外麻醉，对比短期认知功能相关指标。结果 两组患麻醉前、麻醉后6h、72h的MMSE评分无显著差异，（P>0.05）；研究组患者麻醉后12h、24h的MMSE评分明显高于参照组，差异显著，（P<0.05）。研究组患者麻醉后6h、12h、24h的POCD发生率均明显低于参照组，差异显著，（P<0.05）；两组患者麻醉后72h的POCD发生率无显著差异，（P>0.05）。结论 相比于全身麻醉，硬膜外麻醉对老年骨科手术患者短期认知功能影响更小，应用安全性更高，故应作为老年骨科患者首选麻醉方式。

【关键词】：全身麻醉；硬膜外麻醉；老年；骨科

Abstract Objective To compare the effect of general anesthesia and epidural anesthesia on the postoperative short-term cognitive function in elderly orthopedic patients. Methods From January to December of 2017， the time of the selected cases was included in 94 elderly patients undergoing orthopedic surgery. Based on the order of admission， the patients were divided into a reference group and a study group. Each of the 47 cases was given general anesthesia and epidural anesthesia. Compare short-term cognitive function related indicators. Results The MMSE scores before and after anesthesia for 6h and 72h were not significantly different between the two groups （P>0.05）. The MMSE scores at 12h and 24h after anesthesia in the study group were significantly higher than those in the reference group （P<0.05）. The incidence of POCD at 6h， 12h and 24h after anesthesia in the study group was significantly lower than that of the reference group （P<0.05）. There was no significant difference in POCD incidence between the two groups at 72h after anesthesia （P>0.05）. Conclusion Compared with general anesthesia， epidural anesthesia has less impact on short-term cognitive function in elderly patients undergoing orthopaedic surgery and has higher safety of application. Therefore， it should be used as the preferred anesthetic method for elderly orthopedic patients.

Keywords General anesthesia； Epidural anesthesia； Elderly； Orthopedics

【中图分类号】R614 【文献标识码】B 【文章编号】1672-3783（2018）10-03--01

手术是治疗老年骨科疾病的主要手段，能够快速改善疾病相关临床症状，促进肢体功能恢复[1]。但是老年患者各项身体机能、中枢系统严重退化，对手术、麻醉的耐受能力减弱，麻醉风险较大，术后短期认知功能障碍（POCD）发生率高。关于POCD的发生机制现阶段并没有明确认识，其中麻醉时主要影响因素。因此考虑老年患者的特殊性，制定科学的麻醉方案，能够有效降低麻醉对患者认知功能的影响，减少术后短期POCD发生风险。本次以我院老年骨科患者为例，对比全身麻醉、硬膜外麻醉，以确定最佳麻醉方式。

1 资料与方法

1.1 一般资料

94例研究对象，均为2017年1月-12月在我院接受骨科手术治疗的老年患者。按照入院先后顺序分为参照组、研究组，各47例。参照组：男26例，女21例；年龄在62岁-85岁之间，平均（69.02±4.97）歲；A……