CAJ | 학술논문

目的：针对不同麻醉老年患者术后认知功能障碍的状况进行研究和分析。方法从我院2010年1月至2013年12月接收并治疗的人工股骨头置换术患者中随机抽取300例进行回顾性分析，其中男性患者为155例，女性患者为145例，年龄区间在65～89岁之间，平均年龄为74.5岁，体重在46～68kg，通过 asa 分为 ii 级跟 iii 级。并将300例患者随机的分为两组，即全麻组（G 组）150例，脊椎-硬膜外阻滞组（s-e 组）150例。s-e 组中患者采用蛛网膜下腔注射0.5%的罗哌卡因重比重液2ml，时间控制在20s，然后保持原来的体位15分钟，并且要调整患者的麻醉平面，在手术中可以选择性的追加0.5%的罗哌卡因的量，同时在麻醉前的24小时、术后24小时和72小时进行量化功能评分，采用 MMse 量化表，抽取静脉血样并进行血浆β淀粉样蛋白浓度的测定；而 G 组采用的是静脉注射，咪达唑仑为0.1mg/kg，芬太尼3～5μg / kg、异丙酚2mg/kg、维库溴铵0.1 mg / kg 来进行麻醉诱导，并且要将静脉输注的丙泊酚维持在2～3mg·kg-1·h-1，维库溴铵0.04mg / kg，芬太尼 l μg / kg，并且要同时吸入1.5%～2.0%的异氟醚，然后比较两组的效果。结果两组患者病例通过采用不同方式进行麻醉处理后，结果显示，s-e 组的患者病例中患者的认知功能的障碍发生率跟血浆β淀粉样蛋白浓度要比 G 组患者中的低，存在明显差异（P <0.05)。结论通过采用全麻较脊椎-硬膜外阻滞的方式更易导致老年患者在术后的认知功能障碍。
목적：침대불동마취노년환자술후인지공능장애적상황진행연구화분석。방법종아원2010년1월지2013년12월접수병치료적인공고골두치환술환자중수궤추취300례진행회고성분석，기중남성환자위155례，녀성환자위145례，년령구간재65～89세지간，평균년령위74.5세，체중재46～68kg，통과 asa 분위 ii 급근 iii 급。병장300례환자수궤적분위량조，즉전마조（G 조）150례，척추-경막외조체조（s-e 조）150례。s-e 조중환자채용주망막하강주사0.5%적라고잡인중비중액2ml，시간공제재20s，연후보지원래적체위15분종，병차요조정환자적마취평면，재수술중가이선택성적추가0.5%적라고잡인적량，동시재마취전적24소시、술후24소시화72소시진행양화공능평분，채용 MMse 양화표，추취정맥혈양병진행혈장β정분양단백농도적측정；이 G 조채용적시정맥주사，미체서륜위0.1mg/kg，분태니3～5μg / kg、이병분2mg/kg、유고추안0.1 mg / kg 래진행마취유도，병차요장정맥수주적병박분유지재2～3mg·kg-1·h-1，유고추안0.04mg / kg，분태니 l μg / kg，병차요동시흡입1.5%～2.0%적이불미，연후비교량조적효과。결과량조환자병례통과채용불동방식진행마취처리후，결과현시，s-e 조적환자병례중환자적인지공능적장애발생솔근혈장β정분양단백농도요비 G 조환자중적저，존재명현차이（P <0.05)。결론통과채용전마교척추-경막외조체적방식경역도치노년환자재술후적인지공능장애。
Objective to conduct research and analysis of the situation of the different cognitive dysfunction after anesthesia in elderly patients . Methods from our hospital from January 2011 to december 2012 to receive and treat the hemiarthroplasty patients randomly selected 300 cases were retrospectively analyzed 155 cases of patients were male , 145 female patients , age range at between 65 ~ 89 years, mean age was 74.5 years old , weighing 46-68kg, divided by grade ii with asa class iii . and 300 patients were randomly divided into two groups, namely the general anesthesia group (G group ) 150 cases , spinal - epidural anesthesia group (se group ) 150 cases . se group of patients with subarachnoid injection of 0.5% hyperbaric ropivacaine solution 2ml, time control in 20s, then 15 minutes to maintain the original position , and to adjust the patient's anesthesia , the surgery can be selectively an additional amount of 0.5% ropivacaine , and 24 hours before anesthesia , 24 hours and 72 hours after surgery to quantify the functional score , using the MMse quantization table , and venous blood samples were measured in plasma β -amyloid protein concentration ; the group G is used in intravenous midazolam was 0.1mg/kg, fentanyl 3 ~ 5μg/kg, propofol 2mg/kg,, vecuronium 0.1 mg / kg for induction of anesthesia , and to intravenous infusion of propofol was maintained at 2-3mg · kg-1 · h-1, vecuronium 0.04mg/kg, fentanyl l μg / kg, and inhalation of 1.5% to 2.0% while the isoflurane , and then compare the effect of two groups . Results the two groups of cases by using different ways of anesthesia after treatment showed that patients with disorders of cases se group cognitive function in patients with the incidence than the G protein concentration in plasma β -amyloid in the group of patients is low, the presence of significant difference (P <0.05). Conclusion By using spinal anesthesia compared - epidural approach has resulted in cognitive dysfunction in elderly patients after surgery .