中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2012年
2期
144-146
,共3页
夏燕飞%黄浩%周嘉莉%罗妙妙
夏燕飛%黃浩%週嘉莉%囉妙妙
하연비%황호%주가리%라묘묘
麻醉,全身%麻醉,硬膜外%认知障碍
痳醉,全身%痳醉,硬膜外%認知障礙
마취,전신%마취,경막외%인지장애
Anesthesia,general%Anesthesia,epidural%Cognition disorders
目的 观察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 选择全髋关节置换或股骨骨折切复内固定手术患者120例,美国麻醉医师协会(ASA)病情分级Ⅰ、Ⅱ级,数字抽签随机分为全身麻醉组和硬膜外麻醉组各60例.记录术前、麻醉后手术前、手术30 min、主要手术步骤操作时、手术结束时等不同时点平均动脉压和心率,采用简易精神状况检查(MMS)测定两组患者不同时间点的认知功能. 结果 两组患者术中平均动脉压、心率比较,差异无统计学意义(均P＞0.05).MMS评分全身麻醉组麻醉结束6、12、24 h[分别为(26.5±0.5)、(25.4±0.7)、(27.4±0.3)分]与麻醉诱导前[(29.5±0.3)分]比较,差异有统计学意义(均P＜0.05),与麻醉结束72 h[(29.2±0.3)分]比较,差异无统计学意义(P＞0.05)；硬膜外麻醉组麻醉结束6、12 h[分别为(26.6±0.4)、(25.6±0.8)分]与麻醉诱导前[(29.4±0.4)分]比较,差异有统计学意义(均P＜0.05),麻醉结束24、72 h[分别为(29.1±0.4)、(29.5±0.4)分]与麻醉诱导前比较,差异无统计学意义(P＞0.05).在麻醉结束后24 h,硬膜外麻醉组患者的MMS评分为(29.1±0.4)分,高于全身麻醉组(27.4±0.3)分,差异有统计学意义(P＜0.01). 结论 全身麻醉在术后12 h内对老年骨科患者认知功能的影响较硬膜外麻醉更为明显.
目的 觀察全身痳醉和硬膜外痳醉對老年骨科患者術後短期認知功能的影響. 方法 選擇全髖關節置換或股骨骨摺切複內固定手術患者120例,美國痳醉醫師協會(ASA)病情分級Ⅰ、Ⅱ級,數字抽籤隨機分為全身痳醉組和硬膜外痳醉組各60例.記錄術前、痳醉後手術前、手術30 min、主要手術步驟操作時、手術結束時等不同時點平均動脈壓和心率,採用簡易精神狀況檢查(MMS)測定兩組患者不同時間點的認知功能. 結果 兩組患者術中平均動脈壓、心率比較,差異無統計學意義(均P＞0.05).MMS評分全身痳醉組痳醉結束6、12、24 h[分彆為(26.5±0.5)、(25.4±0.7)、(27.4±0.3)分]與痳醉誘導前[(29.5±0.3)分]比較,差異有統計學意義(均P＜0.05),與痳醉結束72 h[(29.2±0.3)分]比較,差異無統計學意義(P＞0.05)；硬膜外痳醉組痳醉結束6、12 h[分彆為(26.6±0.4)、(25.6±0.8)分]與痳醉誘導前[(29.4±0.4)分]比較,差異有統計學意義(均P＜0.05),痳醉結束24、72 h[分彆為(29.1±0.4)、(29.5±0.4)分]與痳醉誘導前比較,差異無統計學意義(P＞0.05).在痳醉結束後24 h,硬膜外痳醉組患者的MMS評分為(29.1±0.4)分,高于全身痳醉組(27.4±0.3)分,差異有統計學意義(P＜0.01). 結論 全身痳醉在術後12 h內對老年骨科患者認知功能的影響較硬膜外痳醉更為明顯.
목적 관찰전신마취화경막외마취대노년골과환자술후단기인지공능적영향. 방법 선택전관관절치환혹고골골절절복내고정수술환자120례,미국마취의사협회(ASA)병정분급Ⅰ、Ⅱ급,수자추첨수궤분위전신마취조화경막외마취조각60례.기록술전、마취후수술전、수술30 min、주요수술보취조작시、수술결속시등불동시점평균동맥압화심솔,채용간역정신상황검사(MMS)측정량조환자불동시간점적인지공능. 결과 량조환자술중평균동맥압、심솔비교,차이무통계학의의(균P＞0.05).MMS평분전신마취조마취결속6、12、24 h[분별위(26.5±0.5)、(25.4±0.7)、(27.4±0.3)분]여마취유도전[(29.5±0.3)분]비교,차이유통계학의의(균P＜0.05),여마취결속72 h[(29.2±0.3)분]비교,차이무통계학의의(P＞0.05)；경막외마취조마취결속6、12 h[분별위(26.6±0.4)、(25.6±0.8)분]여마취유도전[(29.4±0.4)분]비교,차이유통계학의의(균P＜0.05),마취결속24、72 h[분별위(29.1±0.4)、(29.5±0.4)분]여마취유도전비교,차이무통계학의의(P＞0.05).재마취결속후24 h,경막외마취조환자적MMS평분위(29.1±0.4)분,고우전신마취조(27.4±0.3)분,차이유통계학의의(P＜0.01). 결론 전신마취재술후12 h내대노년골과환자인지공능적영향교경막외마취경위명현.
Objective To study the influence of general anesthesia and epidural anesthesia on postoperative short-term cognitive function in the elderly patients undergoing orthopedics surgery.Methods 120 patients with hip joint displacement or internal fixation after femur fracture and American Society of Anesthesiology Ⅰ and Ⅱ were randomly divided into general anesthesia and epidural anesthesia groups(n=60 for each group).Artery blood pressure(ABP)and heart rate were recorded before operation,pre-operation after anesthesia,during 30 min operation,during main operation and at operation end.Cognitive function was detected by mini-mental state(MMS)before induction of anesthesia and 6 h,12 h,24 h and 72 h after anesthesia.Results There were no differences in ABP and heart rate during operation between the two groups(P＞0.05).The scores of MMS in general anesthesia group at 6 h(26.5±0.5),12 h(25.4±0.7)and 24 h(27.4±0.3)were decreased as compared with pre-induction of anesthesia(29.5 ± 0.3)(P＜ 0.05),while no difference was found at 72 h(29.3±0.3).The scores of MMS in epidural anesthesia group at 6 h(26.6±0.4)and 12 h(25.6±0.8)were lower(P＜0.05),while had no difference at 24 h(29.1±0.4)and 72 h (29.5±0.4)(P＞0.05)as compared with pre-induction of anesthesia(29.4±0.4).At 24 h after anesthesia,the MMS scores were higher in epidural anesthesia group(29.1±0.4)than in general anesthesia group(27.4±0.3)(P＜0.01).Conclusions General anesthesia may contribute to more obvious influences on cognitive function than epidural anaesthesias within 12h after operation in the elderly patients undergoing orthopedics surgery.
