CAJ | 학술논문

目的探明青年患者小手术后近期认知功能的变化.方法择期行脐部以下部位小手术(手术时间＜2 h)青年患者(18岁～39岁)60例,ASA Ⅰ～Ⅱ级,采用完全随机设计法分为全凭静脉麻醉组与硬膜外麻醉组各30例,对照组为青年健康志愿者30例.分别于术前1 d,术后3 d行6项认知功能测定.结果完成全程测验60例,其中对照组21例,全麻组18例,硬膜外组21例.术后各项测验值普遍高于术前测验值(P＜0.05).全麻组和硬膜外组多项测验数值在术前和术后低于对照组(P＜0.05).按Z计分诊断术后第3天认知功能障碍(postoperative cognitive dysfunction,POCD)发生5例,其中对照组1例,全麻组3例,硬膜外组1例.组间差异无统计学意义(x2=2.338,P=0.31).结论小手术青年患者在术前注意力已有所下降,术后注意力、记忆力和思维能力都有一定程度的受损.全身麻醉和硬膜外麻醉后近期各项认知功能的变化及POCD的发生率差异无统计学意义.
목적 탐명청년환자소수술후근기인지공능적변화.방법 택기행제부이하부위소수술(수술시간＜2 h)청년환자(18세～39세)60례,ASA Ⅰ～Ⅱ급,채용완전수궤설계법분위전빙정맥마취조여경막외마취조각30례,대조조위청년건강지원자30례.분별우술전1 d,술후3 d행6항인지공능측정.결과 완성전정측험60례,기중대조조21례,전마조18례,경막외조21례.술후각항측험치보편고우술전측험치(P＜0.05).전마조화경막외조다항측험수치재술전화술후저우대조조(P＜0.05).안Z계분진단술후제3천인지공능장애(postoperative cognitive dysfunction,POCD)발생5례,기중대조조1례,전마조3례,경막외조1례.조간차이무통계학의의(x2=2.338,P=0.31).결론 소수술청년환자재술전주의력이유소하강,술후주의력、기억력화사유능력도유일정정도적수손.전신마취화경막외마취후근기각항인지공능적변화급POCD적발생솔차이무통계학의의.
Objective To investigate the short-term postoperative cognitive function change in young patients undergoing minor surgery. Methods 60 young patients ( 18 y-39 y old) scheduled for minor surgery (operation time ＜2 h, below the level of umbilicus) were recruited and classified randomly into two groups: general anesthesia group and epidural anesthesia group, and control group were composed of 30 young healthy volunteers. A set of six neuropsychological tests from the Wechsler Adult Intelligence Scale was administered on two occasions: 1st day before operation (baseline) and 3rd day after operation. Results 60 objects had finished all the tests, 21 cases in control group, 18 cases in general anesthesia group and 21 cases in epidural group.Most of test scores after operation were significantly higher than test scores before operation (P＜0.05). Some of test scores before and after operation in both general anesthesia group and epidural anesthesia group were significantly lower than that of control group (P＜0.05 )respectively. According to Z score definition, there were total 5 cases diagnosed as postoperative cognitive dysfunction(POCD).Among the 5 cases, there was 1 case in control group, 3 cases in general anesthesia group and 1 case in epidural anesthesia group.The differences among groups showed no statistical significance(x2=2.338,P=0.31 ). Conclusion Impairment of cognitive function of surgical patients has occurred not only postoperatively but also preoperatively. According to the results of six neuropsychological tests and the incidence of POCD, there is no significant differences between general anesthesia and epidural anesthesia.