CAJ | 학술논문

目的比较不同麻醉老年患者术后认知功能障碍的发生.方法择期拟行人工股骨头置换术患者93例,性别不限,年龄≥65岁,体重45 ～ 67 kg,ASA分级Ⅱ或Ⅲ级.采用随机数字表法,将其分为2组:全麻组(G组,n =47)和脊椎-硬膜外阻滞组(S-E组,n=46).G组静脉注射咪达唑仑0.1 mg/kg、异丙酚2 mg/kg、芬太尼3～5 μg/kg、维库溴铵0.1 mg/kg麻醉诱导,麻醉维持:静脉输注丙泊酚2～3 mg·kg-1·h-1,间断静脉注射芬太尼l μg/kg和维库溴铵0.04 mg/kg,吸入1.5％～2.0％异氟醚；S-E组蛛网膜下腔注射0.5％罗哌卡因重比重液2 ml,注药时间20 s,注药后保持原体位15 min,同时调整麻醉平面至患侧T8以下,术中根据需要硬膜外追加0.5％罗哌卡因3～5 ml.分别于麻醉前24h、术后24h和72 h时,采用MMSE量表进行认知功能评分,采集肘静脉血样,ELISA法测定血浆β淀粉样蛋白浓度.结果与G组比较,S-E组术后24 h时术后认知功能障碍发生率及血浆β淀粉样蛋白浓度降低(P＜0.05).结论全麻较脊椎-硬膜外阻滞老年患者更易发生术后认知功能障碍.
목적 비교불동마취노년환자술후인지공능장애적발생.방법 택기의행인공고골두치환술환자93례,성별불한,년령≥65세,체중45 ～ 67 kg,ASA분급Ⅱ혹Ⅲ급.채용수궤수자표법,장기분위2조:전마조(G조,n =47)화척추-경막외조체조(S-E조,n=46).G조정맥주사미체서륜0.1 mg/kg、이병분2 mg/kg、분태니3～5 μg/kg、유고추안0.1 mg/kg마취유도,마취유지:정맥수주병박분2～3 mg·kg-1·h-1,간단정맥주사분태니l μg/kg화유고추안0.04 mg/kg,흡입1.5％～2.0％이불미；S-E조주망막하강주사0.5％라고잡인중비중액2 ml,주약시간20 s,주약후보지원체위15 min,동시조정마취평면지환측T8이하,술중근거수요경막외추가0.5％라고잡인3～5 ml.분별우마취전24h、술후24h화72 h시,채용MMSE량표진행인지공능평분,채집주정맥혈양,ELISA법측정혈장β정분양단백농도.결과 여G조비교,S-E조술후24 h시술후인지공능장애발생솔급혈장β정분양단백농도강저(P＜0.05).결론 전마교척추-경막외조체노년환자경역발생술후인지공능장애.
Objective To compare the occurrence of postoperative cognitive dysfunction (POCD) in elderly patients using differentanesthetic methods.Methods Ninety-three ASA Ⅱ or Ⅲ patients,aged ≥ 65 yr,weighing 45-67 kg,scheduled for artificial femoral head replacement,were randomly divided into 2 groups:general anesthesia (group G,n =47) and combined spinal-epidural anesthesia group (group S-E,n =46).In group G,anesthesia was induced with iv injection of midazolam 0.1 mg/kg,propofol 2 mg/kg,fentanyl 3-5μg/kg,and vecuronium 0.1 mg/kg,and maintained with continuous infusion of propofol 2-3 mg· kg-1 · h-1,intermittent iv boluses of fentanyl 1 μg/kg and vecuronium 0.04 mg/kg and inhalation of 1.5％-2.0％ isoflurane.In group S-E,hyperbaric 0.5 ％ ropivacaine 2 ml was injected into the subarachnoid space over 20 s,the patients were kept in the original position for 15 min,the level of anesthesia was simultaneously adjusted to below T8 on the operated side,and 0.5 ％ ropivacaine 3-5 ml was injected into the epidural space when needed during operation.Cognitive function was assessed by mini-mental state examination at 24 h before anesthesia and 24 and 72 h after operation.Venous blood samples were collected for determination of plasma amyloid-beta levels by ELISA.Results Compared with group G,the incidence of POCD at 24 h after operation and level of plasma amyloid-beta were significantly decreased in group S-E (P ＜ 0.05).Conclusion Elderly patients are more likely to develop POCD under general anesthesia than under combined spinal-epidural anesthesia.