全麻联合硬膜外阻滞对老年直肠癌患者术后认知功能的影响
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摘要
目的探讨全身麻醉联合硬膜外阻滞对老年直肠癌患者术后苏醒质量和认知功能的影响。方法选择2014年1月至2016年12月在南通市通州区中医院行直肠癌根治术的患者74例,采用随机数字法分为全身麻醉+硬膜外阻滞组(观察组)和单纯全身麻醉组(对照组),每组37例。比较两组患者术中丙泊酚和瑞芬太尼的用量、拔管参数以及术后认知功能的评分。结果观察组患者睁眼时间、呼吸恢复时间、定力恢复时间、拔管时间和苏醒期躁动例数均低于对照组(P<0.001),差异具有统计学意义;与对照组相比,观察组患者丙泊酚和瑞芬太尼用量也明显减少(P<0.001)差异具有统计学意义;对照组患者术后1 d和3 d简易智能精神状态检查量表(mini-mental state examination, MMSE)评分和蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)评分较术前均下降,但是观察组术后1 d和3 d MMSE和MoCA平均评分高于对照组,差异具有统计学意义。结论全麻联合硬膜外阻滞麻醉可以减轻老年直肠癌患者术后认知功能障碍,提高苏醒期质量并减少全麻药物用量。
Objective To investigate the effect of general anesthesia combined with epidural block on postoperative recovery quality and cognitive function in elderly patients with rectal cancer. Methods A total of 74 patients with radical resection of rectal cancer in our hospital from January 2014 to December 2016 were enrolled. The patients were divided into general anesthesia and epidural block(observation group) and general anesthesia group(control group) by random number method with 37 cases in each group. The doses of propofol and remifentanil, extubation parameters, and postoperative cognitive function scores were compared between the two groups.Results The blinking time, respiratory recovery time, duration of recovery, duration of extubation, and number of awakening during recovery were lower in the observation group than those in the control group significantly(all P<0.05); In comparison, the amount of propofol and remifentanil in the observation group was also significantly reduced(P<0.05). The mini-mental state examination(MMSE) and Montreal Cognitive Assessment(MoCA) scores of the observation group were higher than those of the control group at 1 and 3 days after operation significantly.Conclusions General anesthesia combined with epidural block can alleviate postoperative cognitive dysfunction in elderly patients with rectal cancer, improve the quality of recovery and reduce the dose of general anesthesia.
Objective To investigate the effect of general anesthesia combined with epidural block on postoperative recovery quality and cognitive function in elderly patients with rectal cancer. Methods A total of 74 patients with radical resection of rectal cancer in our hospital from January 2014 to December 2016 were enrolled. The patients were divided into general anesthesia and epidural block(observation group) and general anesthesia group(control group) by random number method with 37 cases in each group. The doses of propofol and remifentanil, extubation parameters, and postoperative cognitive function scores were compared between the two groups.Results The blinking time, respiratory recovery time, duration of recovery, duration of extubation, and number of awakening during recovery were lower in the observation group than those in the control group significantly(all P<0.05); In comparison, the amount of propofol and remifentanil in the observation group was also significantly reduced(P<0.05). The mini-mental state examination(MMSE) and Montreal Cognitive Assessment(MoCA) scores of the observation group were higher than those of the control group at 1 and 3 days after operation significantly.Conclusions General anesthesia combined with epidural block can alleviate postoperative cognitive dysfunction in elderly patients with rectal cancer, improve the quality of recovery and reduce the dose of general anesthesia.
引文
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[11] O’Bryant SE,Humphreys JD,Smith GE,et al.Detecting dementia with the mini-mental state examinationin highly educated individual[J].Arch Neuro,2008,65(7):963-967.
[12] Nasreddine ZS,Phillips NA,Bédirian V,et al.The Montreal Cognitive Assessment,MoCA:a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53(4):695-699.
[2] Rosezyk HA,Sparkman NL,Johnson RW.Neuroinflammation and cognitive function in aged mice following minor surgery[J].ExP Gerontol,2008,43(9):840-846.
[3] Vanderweyde T,Bendar MM,Forman SA,et al.Latrogenic risk factors for Alzheiranr’s disease:surgery and anesthesia[J].J Alzhehners Dis,2010,22 Suppl3:91-104.
[4] Moselli NM,Baricocchi E,Ribero D,et al.Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma.Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia[J].Ann Surg Oncol,2011,18(10):2722-2731.
[5] Nasreddine ZS,Phillips NA,Bédirian V,et al.The Montreal Cognitive Assessment,MoCA:a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53(4):695-699.
[6] 岳云.老年患者术后认知功能障碍的再认识[J].临床麻醉学杂志,2013,29(10):1035-1038.
[7] Moller JT,Cluitmans P,Rasmussen LS,et al.Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study.ISPOCD investigators.International Study of Post-Operative Cognitive Dysfunction[J].Lancet,1998,351(9106):857-861.
[8] Steinmetz J,Christensen KB,Lund T,et al.Long-term consequences of postoperative cognitive dysfunction[J].Anesthesiology,2009,110(3):548-555.
[9] Selwood A,Orrell M.Long term cognitive dysfunction in older people after non-cardiac surgery[J].BMJ,2004,328(7432):120-121.
[10] 章放香,宁俊平,邱冰,等.不同麻醉老年患者术后认知功能障碍发生的比较[J].中华麻醉学杂志,2013,33(2):188-190.
[11] O’Bryant SE,Humphreys JD,Smith GE,et al.Detecting dementia with the mini-mental state examinationin highly educated individual[J].Arch Neuro,2008,65(7):963-967.
[12] Nasreddine ZS,Phillips NA,Bédirian V,et al.The Montreal Cognitive Assessment,MoCA:a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53(4):695-699.