硬膜外麻醉对老年前列腺电切术患者认知功能的影响
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摘要
目的探讨硬膜外麻醉对老年前列腺电切术患者术后认知功能的影响。方法选取驻马店市中心医院2016年5月—2018年2月收治的106例行前列腺电切术老年患者,将其随机分成例数均等的两组,对照组采取全身麻醉方式,观察组患者实施硬膜外麻醉,比较两组麻醉效果和并发症及不良反应发生情况,采用简易精神状况检查量表(MMSE)评价患者术前术后认知功能情况。结果两组麻醉起效时间及麻醉效果比较,差异无统计学意义(P>0.05),观察组麻醉恢复时间明显短于对照组,差异有统计学意义(P<0.01);观察组心动过缓、尿潴留和低血压的发生率显著低于对照组,差异有统计学意义(P<0.05),两组患者术前MMSE得分无显著性差异(P>0.05),术后7 d、术后1个月时,观察组患者MMSE得分明显高于对照组(P<0.01),对照组术后MMSE得分低于术前(P<0.05)。结论硬膜外麻醉应用于前列腺电切术老年患者中麻醉效果满意,并发症及不良反应发生率低,对患者的认知功能影响较小,安全可行。
OBjECTIVE To investigate the effect of epidural anesthesia on postoperative cognitive function in elderly patients undergoing transurethral resection of prostate. Methods METHODS 106 elderly patients who underwent transurethral resection of prostate in target hospital from May 2017 to February 2018 were selected. They were randomly divided into 2 equal groups,the control group received general anesthesia,and the observation group received epidural anesthesia. The anesthetic effects,complications and adverse reactions of the two groups were compared,the mini mental state examination scale(MMSE)was used to evaluate the preoperative and postoperative cognitive function. RESULTS There was no significant difference in onset time and anesthetic effect between the two groups(P>0.05). The recovery time of anesthesia in the observation group was significantly shorter than that in the control group(P<0.01). The incidence of bradycardia, urinary retention and hypotension in the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in preoperative MMSE score between the 2 groups(P>0.05). After 7d and 1 months after operation,the MMSE score of the observation group was significantly higher than that of the control group(P<0.01),and the MMSE score in the control group was lower than that before operation(P<0.05). CONCLUSION The effect of epidural anesthesia in the elderly patients with prostatic electrocutting was satisfactory,the incidence of complications and adverse reactions was low,and the cognitive function of the patients is less affected,and it was safe and feasible.
OBjECTIVE To investigate the effect of epidural anesthesia on postoperative cognitive function in elderly patients undergoing transurethral resection of prostate. Methods METHODS 106 elderly patients who underwent transurethral resection of prostate in target hospital from May 2017 to February 2018 were selected. They were randomly divided into 2 equal groups,the control group received general anesthesia,and the observation group received epidural anesthesia. The anesthetic effects,complications and adverse reactions of the two groups were compared,the mini mental state examination scale(MMSE)was used to evaluate the preoperative and postoperative cognitive function. RESULTS There was no significant difference in onset time and anesthetic effect between the two groups(P>0.05). The recovery time of anesthesia in the observation group was significantly shorter than that in the control group(P<0.01). The incidence of bradycardia, urinary retention and hypotension in the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in preoperative MMSE score between the 2 groups(P>0.05). After 7d and 1 months after operation,the MMSE score of the observation group was significantly higher than that of the control group(P<0.01),and the MMSE score in the control group was lower than that before operation(P<0.05). CONCLUSION The effect of epidural anesthesia in the elderly patients with prostatic electrocutting was satisfactory,the incidence of complications and adverse reactions was low,and the cognitive function of the patients is less affected,and it was safe and feasible.
引文
[1]陈美娥.不同麻醉方案对老年前列腺电切术患者认知功能障碍的影响[J].中国基层医药,2017,24(10):1469-1473.
[2] TEWARI A,DHAWAN I,MAHENDRU V,et al. A comparative study evaluating the prophylactic efficacy of oral clonidine and tramadol for perio perative shivering in geriatric patients undergoing transurethral resection of prostate[J]. J anaesthesiol clin pharmacol,2014,30(3):340.
[3]钱晓岚,郭晓辉,任莹莹,等.术后认知功能障碍的相关因素与病理机制研究进展[J].中国实用医刊,2016,43(18):124-126.
[4]高彦东,艾伟,郭宇峰,等.术中呼气末二氧化碳分压对老年患者全麻术后认知功能障碍和S100β蛋白水平的影响[J].中国临床研究,2016,29(1):87-89.
[5]徐化雪,喻刚国.全身麻醉和硬膜外麻醉对老年全髋关节置换患者术后短期认知功能的影响[J].中国基层医药,2015,22(3):462-464.
[6] TRABOLD B,METTERLEIN T. Postoperative delirium:risk factors,prevention,and treatment[J]. J Cardiothothorac Vasc Anesth,2014,28(5):1352-1360.
[7]蔡玉红,施美新,黄翠风.经尿道前列腺电切术的麻醉处理[J].中国现代药物应用,2015,2(9):132-134.
[8] DEVITT J H, WENSTONE R, NOEL A G, et al. The laryngeal mask airway and positice-pressure Ventilation[J]. Anesthesiologu,2013,80(9):550-555.
[9]杨虎,闫慈,王波,等. SLIPA喉罩麻醉在老年患者前列腺电切术的临床应用[J].新疆医学,2017,47(8):845-848.
[10]赵素敏,蒋艳东,谷志杰,等.瑞芬太尼与芬太尼在老年前列腺电切术麻醉中的效果比较[J].中国综合临床,2013,29(10):1085-1087.
[11] KSE O,SALAM H S,ALTUN M E,et al. Prilocaine irrigation for pain relief after transurethral resection of the prostate[J]. J endourol,2013,27(7):892-895.
[2] TEWARI A,DHAWAN I,MAHENDRU V,et al. A comparative study evaluating the prophylactic efficacy of oral clonidine and tramadol for perio perative shivering in geriatric patients undergoing transurethral resection of prostate[J]. J anaesthesiol clin pharmacol,2014,30(3):340.
[3]钱晓岚,郭晓辉,任莹莹,等.术后认知功能障碍的相关因素与病理机制研究进展[J].中国实用医刊,2016,43(18):124-126.
[4]高彦东,艾伟,郭宇峰,等.术中呼气末二氧化碳分压对老年患者全麻术后认知功能障碍和S100β蛋白水平的影响[J].中国临床研究,2016,29(1):87-89.
[5]徐化雪,喻刚国.全身麻醉和硬膜外麻醉对老年全髋关节置换患者术后短期认知功能的影响[J].中国基层医药,2015,22(3):462-464.
[6] TRABOLD B,METTERLEIN T. Postoperative delirium:risk factors,prevention,and treatment[J]. J Cardiothothorac Vasc Anesth,2014,28(5):1352-1360.
[7]蔡玉红,施美新,黄翠风.经尿道前列腺电切术的麻醉处理[J].中国现代药物应用,2015,2(9):132-134.
[8] DEVITT J H, WENSTONE R, NOEL A G, et al. The laryngeal mask airway and positice-pressure Ventilation[J]. Anesthesiologu,2013,80(9):550-555.
[9]杨虎,闫慈,王波,等. SLIPA喉罩麻醉在老年患者前列腺电切术的临床应用[J].新疆医学,2017,47(8):845-848.
[10]赵素敏,蒋艳东,谷志杰,等.瑞芬太尼与芬太尼在老年前列腺电切术麻醉中的效果比较[J].中国综合临床,2013,29(10):1085-1087.
[11] KSE O,SALAM H S,ALTUN M E,et al. Prilocaine irrigation for pain relief after transurethral resection of the prostate[J]. J endourol,2013,27(7):892-895.