刘立涛　王志宁　刘晓鹏　徐家济

[關键词] 椎管内麻醉;全身麻醉;老年人;术后认知功能障碍

[中图分类号] R614.2          [文献标识码] B          [文章编号] 1673-9701（2021）17-0116-04

Effects of different anesthetic methods on postoperative cognitive function of elderly patients with mild cognitive impairment

LIU Litao1   WANG Zhining2   LIU Xiaopeng3   XU Jiaji1

1.Department of Anesthesiology，Beijing Fengtai Youanmen Hospital， Beijing   100069，China;2.Department of Anesthesiology，Shenzhou Hospital in Hebei Province，Shenzhou   053800，China;3.Department of Anesthesiology，Beijing You'an Hospital， Capital Medical University， Beijing   100069，China

[Abstract] Objective To investigate the effects of two different anesthesia methods on the incidences of postoperative cognitive dysfunction （POCD） in elderly patients with mild cognitive impairment（MCI）. Methods A total of 120 patients who underwent unilateral knee arthroplasty in Youanmen Hospital of Beijing Fengtai and Shenzhou Hospital of Hebei Province from July 2018 to November 2020 were selected and randomly divided into two groups， with 60 patients in each group. Patients in group A were given intraspinal anesthesia， and patients in group B were given intravenous general anesthesia. The MMSE scores and MOCA scores of all subjects on the day before surgery（T0） and the 7th day after surgery（T1） were observed and recorded. The incidences of POCD in elderly patients in the two groups was recorded. The concentrations of IL-10 and TNF-α at T0 and T1 and the analgesia demand of patients in the two groups were recorded and compared. Results The postoperative MoCA score and MMSE score in group A were significantly higher than those in group B （P<0.05）. The postoperative concentration of interleukin 10 （IL-10） in group A was significantly higher than that in group B （P<0.05）， while the postoperative concentration of tumor necrosis factor （TNF-α） in group A was significantly lower than that in group B（P<0.05）. The incidence of postoperative POCD between group A and group B was 26.67% and 32.20% respectively， and there was no significant difference between the two groups（P>0.05）. Conclusion There is no significant difference in the incidence of POCD between spinal anesthesia and general anesthesia in elderly patients with mild cognitive impairment during knee arthroplasty operation.

[Key words] Intraspinal anesthesia; General anesthesia; Elderly people; Postoperative cognitive dysfunction

轻度认知功能障碍（Mild cognitive impairment，MCI）是介于正常老化和老年痴呆之间的一种临床状态。目前临床上老年患者常常术前伴有MCI，研究表明这类人群术后更容易發生术后认知功能障碍（Postoperative cognitive dysfunction，POCD）。以往研究显示，任何年龄的患者术后均有可能发生POCD，但尤其是老年人更容易发生POCD，其主要临床表现为判断力和记忆力严重降低，而且还引起明显的人格改变，将显著延长术后患者的住院时间，导致患者和医院的医疗费用支出明显增加。

另一方面，以往研究显示，不同的麻醉方法会对老年人POCD产生不同的影响，老年人围术期采用椎管内麻醉方法相比采用全身麻醉方法更有利于降低老年人POCD的发生[1-4]，但对于不伴有轻度认知功能障碍老年患者术后认知功能的影响目前还不清楚。因此，本研究拟评价两种不同方式麻醉对伴有MCI的老年患者POCD的影响，并为临床提供参考，现报道如下。

1 对象与方法

1.1 研究对象

该研究方案在北京丰台右安门医院获得伦理委员会的批准，选择2018年7月至2020年11月在北京丰台右安门医院和河北省深州市医院择期行单侧膝关节置换术的老年患者120例。纳入标准：ASA分级Ⅰ～Ⅱ级，年龄65～80岁，体重50～80 kg，术前认知评估量表（Montreal cognitive assessment， MoCA）评分为15～24分，而简易精神状态量表 （the Mini mental state examination， MMSE）评分为21～26分，临床痴呆评定量表（Clinical dementia rating，CDR）评分为0.5分，日常生活活动量表（Instrumental activities of daily living scale，IADL）评分为16～21分的老年患者。排除标准：伴有……