CAJ | 학술논문

目的：探讨硬膜外麻醉、单纯全身麻醉、全身麻醉复合硬脊膜外阻滞对老年患者术后早期认知功能、苏醒质量及应激反应的影响。方法将行手术治疗的228例老年患者按照随机数字表法分为硬膜外组（予硬膜外麻醉）75例、全麻组（予全身麻醉）76例、全麻复合组（予全身麻醉复合硬脊膜外阻滞）77例，采用简易智能精神状态量表（ MMSE ）评定3组患者术前及术后12 h、1 d、3 d、7 d、1个月的神经精神功能。采用运动活动评分（ MAAS）评估患者术前及术后30 min、6 h的镇静程度，并采集相应时间段患者静脉血样检测肾上腺素、去甲肾上腺素、皮质醇、血糖水平。结果认知障碍主要发生在术后24 h内，术后7 d除全麻组有3例发生认知障碍外，其余均恢复正常；全麻组出现术后认知障碍的比例最大、最为严重，全麻复合组次之，3组之间比较差异有统计学意义（P均＜0．05）；发生术后认知障碍的患者均于术后1个月恢复正常。硬膜外组术后30 min MAAS评分明显低于全麻组和全麻复合组（P均＜0．05），全麻组和全麻复合组术后30 min、6 h肾上腺素、去甲肾上腺素、皮质醇、血糖水平均明显高于术前及硬膜外组（P均＜0．05）。结论硬膜外麻醉能有效降低老年患者手术后认知功能障碍的发生率，减轻术后患者的应激反应，可有效提高术后患者的苏醒质量。
목적：탐토경막외마취、단순전신마취、전신마취복합경척막외조체대노년환자술후조기인지공능、소성질량급응격반응적영향。방법장행수술치료적228례노년환자안조수궤수자표법분위경막외조（여경막외마취）75례、전마조（여전신마취）76례、전마복합조（여전신마취복합경척막외조체）77례，채용간역지능정신상태량표（ MMSE ）평정3조환자술전급술후12 h、1 d、3 d、7 d、1개월적신경정신공능。채용운동활동평분（ MAAS）평고환자술전급술후30 min、6 h적진정정도，병채집상응시간단환자정맥혈양검측신상선소、거갑신상선소、피질순、혈당수평。결과인지장애주요발생재술후24 h내，술후7 d제전마조유3례발생인지장애외，기여균회복정상；전마조출현술후인지장애적비례최대、최위엄중，전마복합조차지，3조지간비교차이유통계학의의（P균＜0．05）；발생술후인지장애적환자균우술후1개월회복정상。경막외조술후30 min MAAS평분명현저우전마조화전마복합조（P균＜0．05），전마조화전마복합조술후30 min、6 h신상선소、거갑신상선소、피질순、혈당수평균명현고우술전급경막외조（P균＜0．05）。결론경막외마취능유효강저노년환자수술후인지공능장애적발생솔，감경술후환자적응격반응，가유효제고술후환자적소성질량。
Objective It is to investigate the influence of epidural anesthesia , simple general anesthesia and general anes-thesia combined with epidural block on early cognitive function , recovery quality and stress response in elderly patients postop-erative.Methods 228 cases of elderly patients with surgical treatment were randomly divided into 3 groups:75 cases in epi-dural group ( epidural anesthesia ) , 76 cases in general anesthesia group ( simple general anesthesia ) and 77 cases in Com-bined anesthesia ( general anesthesia combined with epidural block group ) .The nervous mental functions of all patients were evaluated by mini-mental state examination (MMSE) scale before and after 0.5-, 1-, 3-, and 7-day of operation.The sedation degree were evaluated by motor activity assessment scale ( MAAS) before and after 30 min and 6 h, and blood sam-ples were collected to detect the levels of epinephrine , norepinephrine , cortisol and blood glucose .Results Cognitive impair-ment were occured mainly in postoperative within 24 h.On the 7th day of postoperative , all the patients were recovered normal except for 3 cases of cognitive dysfunction in general anesthesia group; the ratio of postoperative cognitive impairment in the general anesthesia group was the biggest , and most serious , and better in combined anesthesia group , there was significant differences between the three groups (all P<0.05); all the patients of postoperative cognitive impairment were recovered to normal in postoperative 1 months.The MAAS score after postoperative 30 min in epidural group was significantly lower than that in epidural anesthesia group and combined anesthesia group ( all P<0 .05 ) , the levels of epinephrine , norepinephrine , cortisol and blood glucose in general anesthesia group and combined anesthesia after postoperative 30 min and 6 h were signifi-cantly higher than those in the epidural anesthesia group (all P<0.05).Conclusion Epidural anesthesia can effectively re-duce the incidence of postoperative cognitive dysfunction in elderly patients , reduce the stress reaction of patients , and can ef-fectively improve the recovery quality of patients .