CAJ | 학술논문

目的：比较硬膜外麻醉与全身麻醉（全麻）对老年骨科患者术后短期认知功能的影响。方法将90例老年骨科患者按随机数字表法将其分为观察组和对照组，每组45例。观察组患者实行硬膜外麻醉，对照组患者实行全麻。分别在麻醉前、麻醉6 h、12 h、24 h、72 h 时根据简易精神状况检测（MMSE）量表评估两组患者的认知功能，分别在麻醉前、手术前、手术30 min 以及手术结束监测患者心率（HR）和血压（BP）。结果两组麻醉前和手术前、手术30 min 以及手术后的 HR 比较，差异均无统计学意义（t ＝0．094、0．113、0.188、0．348，均 P ＞0．05）；两组麻醉前和手术前、手术30 min 以及手术后的 BP 比较，差异均无统计学意义（t ＝0．190、0．179、0．181、0．271，均 P ＞0．05）。观察组术后24 h 认知功能恢复情况明显优于对照组（t ＝37.947，P ＜0．01）。观察组麻醉前与麻醉后6 h、12 h 的 MMSE 评分比较，差异均有统计学意义（t ＝37．210、65．118、均 P ＜0．01），麻醉前与麻醉后24 h、72 h 的 MMSE 评分比较，差异无统计学意义（t ＝1．861，P ＞0.05）；对照组麻醉后6 h、12 h、24 h 与麻醉前的 MMSE 评分比较，差异均有统计学意义（t ＝29．912、41．000、39．528，均 P ＜0．01），麻醉后72 h 与麻醉前的 MMSE 评分比较，差异无统计学意义（t ＝1．861，P ＞0．05）。结论硬膜外麻醉方式对老年骨科患者术后短期认知功能影响较小，相较于全麻，具有更为理想的麻醉效果。
목적：비교경막외마취여전신마취（전마）대노년골과환자술후단기인지공능적영향。방법장90례노년골과환자안수궤수자표법장기분위관찰조화대조조，매조45례。관찰조환자실행경막외마취，대조조환자실행전마。분별재마취전、마취6 h、12 h、24 h、72 h 시근거간역정신상황검측（MMSE）량표평고량조환자적인지공능，분별재마취전、수술전、수술30 min 이급수술결속감측환자심솔（HR）화혈압（BP）。결과량조마취전화수술전、수술30 min 이급수술후적 HR 비교，차이균무통계학의의（t ＝0．094、0．113、0.188、0．348，균 P ＞0．05）；량조마취전화수술전、수술30 min 이급수술후적 BP 비교，차이균무통계학의의（t ＝0．190、0．179、0．181、0．271，균 P ＞0．05）。관찰조술후24 h 인지공능회복정황명현우우대조조（t ＝37.947，P ＜0．01）。관찰조마취전여마취후6 h、12 h 적 MMSE 평분비교，차이균유통계학의의（t ＝37．210、65．118、균 P ＜0．01），마취전여마취후24 h、72 h 적 MMSE 평분비교，차이무통계학의의（t ＝1．861，P ＞0.05）；대조조마취후6 h、12 h、24 h 여마취전적 MMSE 평분비교，차이균유통계학의의（t ＝29．912、41．000、39．528，균 P ＜0．01），마취후72 h 여마취전적 MMSE 평분비교，차이무통계학의의（t ＝1．861，P ＞0．05）。결론경막외마취방식대노년골과환자술후단기인지공능영향교소，상교우전마，구유경위이상적마취효과。
Objective To compare the effects of general anesthesia and epidural anesthesia on short -term cognitive function in elderly patients after orthopedic surgery.Methods According to the digital table,90 elderly orthopedic patients were divided into the control group and observation group,45 cases in each group.The control group was given general anesthesia,and the observation group was given epidural anesthesia.Before anesthesia and 6h,12h,12h,72h after anesthesia,cognitive function was detected according to MMSE,and before anesthesia and operation,30min after operation,postoperation heart rate (HR)and blood pressure (BP)were measured.Results Before anesthesia,before operation,30 min intraoperation and after operation,the HR between the two groups had no significant differences(t =0.094,0.113,0.188,0.348,all P >0.05),and BP between the two groups also had no significant differences (t =0.190,0.179,0.181,0.271,all P >0.05).Compared with the scores of MMSE in the control group at postoperative 24h,the scores of MMSE in the observation group was significantly higher (t =37.947, P <0.01).Compared with pre -induction of anesthesia,the scores of MMSE in the observation group at postoperative 6h and 12h were relatively lower(t =37.210,65.118,all P <0.01),but there was no significant difference at 24h and 72h(t =1.861,P >0.05).Compared with pre -induction,the scores of MMSE in the control group at postopera-tive 6h,12h and 24h were significantly lower(t =29.912,41.000,39.528,all P <0.01),while the score of MMSE in the control group at postoperative 72h had no significant difference compared with before anesthesia(t =1.861,P >0.05).Conclusion Compared with general anesthesia,epidural anesthesia has less impact on short -term cognitive function.and the anesthetic effect is better.