全麻复合硬膜外麻醉对老年人腹部手术术后认知功能的影响
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摘要
目的:探讨全麻复合硬膜外麻醉是否可降低老年人腹部手术术后认知功能障碍的发生。
方法:选择60岁以上老年腹部择期手术病人30例,ASA分级Ⅰ～Ⅲ级,术前精神状态相似,无精神病史,随机分成2组,硬膜外复合全麻组(A组)与单纯全麻组(B组),每组15例。A组先行硬膜外麻醉,待硬膜外麻醉平面满意后全麻诱导,气管内插管,丙泊酚维持麻醉,术后行硬膜外镇痛。B组病人常规全麻诱导,气管内插管,丙泊酚、芬太尼维持麻醉,术后行静脉镇痛。记录两组全麻用药量、手术时间、苏醒时间及术中出血量;记录两组术前、术中、术后血流动力学指标;观察两组苏醒情况并行Steward苏醒评分;观察两组术后镇痛情况,并行VAS评分;分别在术前一天及术后七天应用Mini-Mental StateExamination(MMSE)行神经精神测量、术前行SDS抑郁自评量表评分;分别测定术前,术毕,术后24h静脉血清S100ββ蛋白浓度。
结果:(1)两组年龄、体重、术前抑郁评分SDS、术前合并高血压人数、教育程度、ASA分级无明显差异(P＞0.05);(2)两组手术时间、术中出血无明显差异(P＞0.05);与B组比较,A组全麻用药量明显减少,苏醒时间明显缩短(P＜0.01);(3)术中BP、HR显示A组血流动力学较B组平稳(P＜0.05),术后SPO_2A组＞B组(P＜0.05);(4)术后Steward评分、VAS评分两组比较差异有显著性,其中A组苏醒完全,术后镇痛更完善(P＜0.05);(5)MMSE评分显示B组有三例术后出现认知功障碍且术毕S100ββ蛋白水平升高明显(P＜0.05),术后24惺被指粗潦跚八?A组变化不明显(P＞0.05)。
结论:全麻复合硬膜外麻醉可降低老年人腹部手术术后认知功能障碍的发生。
Objective:To observe if combined general and epidural anesthesia for abdominal surgery had the effect that decreasing the incidence of post operative congnitive dysfunction POCD.
Methods:Thirty ASAⅠtoⅢelderly patients with the familiar state before the scheduled abdominal operation were allocated into two groups randomly.Both of the group A(Combined general and epidural anesthesia group,n=15)and group B(general anesthesia,n=15)had the same drug for induction and maintenance.Epidural block were performed and attached to the operation satisfactory plane before induction in Group A,and PCEA was used after operation.BP,HR,SPO2 were measured and bleeding amount,dosage,time for anesthesia,operation,awareness were recorded either.Mini-mental state examination(MMSE)test were given to the patients before the operation and repeated 7 days after it. Steward and VAS test were also used.Blood samples were taken in different times to determine S100ββprotein levels.
Results:There were no significant changes in the aspects of age, weight,ASA degree,SDS scores,time for operation,bleeding amout and etc.(P＞0.05)BP,HR increased significantly after trachea intubation and extubation in group B when there were so stabilization in group A. Time for awake was shorter in group A compared with group B(P＜0.01). Meanwhile,Steward and VAS scores showed a good awareness and analgesia post operation in group A.The scores of MMSE in group B decrease manifest after operation and showed three cases had happened POCD with the manisfest increasing of S100ββprotein.There were little change in group A,and with the time gone,S100ββrecovered to the preoperation levels in group B.
Conclusions:Combined general and epidural anesthesia can reduce the incidence of POCD for the abdominal surgery in elderly.
方法:选择60岁以上老年腹部择期手术病人30例,ASA分级Ⅰ～Ⅲ级,术前精神状态相似,无精神病史,随机分成2组,硬膜外复合全麻组(A组)与单纯全麻组(B组),每组15例。A组先行硬膜外麻醉,待硬膜外麻醉平面满意后全麻诱导,气管内插管,丙泊酚维持麻醉,术后行硬膜外镇痛。B组病人常规全麻诱导,气管内插管,丙泊酚、芬太尼维持麻醉,术后行静脉镇痛。记录两组全麻用药量、手术时间、苏醒时间及术中出血量;记录两组术前、术中、术后血流动力学指标;观察两组苏醒情况并行Steward苏醒评分;观察两组术后镇痛情况,并行VAS评分;分别在术前一天及术后七天应用Mini-Mental StateExamination(MMSE)行神经精神测量、术前行SDS抑郁自评量表评分;分别测定术前,术毕,术后24h静脉血清S100ββ蛋白浓度。
结果:(1)两组年龄、体重、术前抑郁评分SDS、术前合并高血压人数、教育程度、ASA分级无明显差异(P＞0.05);(2)两组手术时间、术中出血无明显差异(P＞0.05);与B组比较,A组全麻用药量明显减少,苏醒时间明显缩短(P＜0.01);(3)术中BP、HR显示A组血流动力学较B组平稳(P＜0.05),术后SPO_2A组＞B组(P＜0.05);(4)术后Steward评分、VAS评分两组比较差异有显著性,其中A组苏醒完全,术后镇痛更完善(P＜0.05);(5)MMSE评分显示B组有三例术后出现认知功障碍且术毕S100ββ蛋白水平升高明显(P＜0.05),术后24惺被指粗潦跚八?A组变化不明显(P＞0.05)。
结论:全麻复合硬膜外麻醉可降低老年人腹部手术术后认知功能障碍的发生。
Objective:To observe if combined general and epidural anesthesia for abdominal surgery had the effect that decreasing the incidence of post operative congnitive dysfunction POCD.
Methods:Thirty ASAⅠtoⅢelderly patients with the familiar state before the scheduled abdominal operation were allocated into two groups randomly.Both of the group A(Combined general and epidural anesthesia group,n=15)and group B(general anesthesia,n=15)had the same drug for induction and maintenance.Epidural block were performed and attached to the operation satisfactory plane before induction in Group A,and PCEA was used after operation.BP,HR,SPO2 were measured and bleeding amount,dosage,time for anesthesia,operation,awareness were recorded either.Mini-mental state examination(MMSE)test were given to the patients before the operation and repeated 7 days after it. Steward and VAS test were also used.Blood samples were taken in different times to determine S100ββprotein levels.
Results:There were no significant changes in the aspects of age, weight,ASA degree,SDS scores,time for operation,bleeding amout and etc.(P＞0.05)BP,HR increased significantly after trachea intubation and extubation in group B when there were so stabilization in group A. Time for awake was shorter in group A compared with group B(P＜0.01). Meanwhile,Steward and VAS scores showed a good awareness and analgesia post operation in group A.The scores of MMSE in group B decrease manifest after operation and showed three cases had happened POCD with the manisfest increasing of S100ββprotein.There were little change in group A,and with the time gone,S100ββrecovered to the preoperation levels in group B.
Conclusions:Combined general and epidural anesthesia can reduce the incidence of POCD for the abdominal surgery in elderly.
引文
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[2]Moller JT,Cluitmans P,Rasmussen IS,et al.Long-termpostoperative cognitive dysfunction in the elderly ISPOCDIstudy.ISPOCD investigators.International Stu of PostoperativeCognitive Dysfunction.Lancet,1998,351:857861.
[3]蔡一榕,薛张纲,朱彪。术后认知功能障碍的危险因素分析。 临床麻醉学杂志,2006,22(8)
[4]冯丽,田玉科,王鹏。老年病人术后认知功能障碍的研究进展。实用医学杂志,2006,22(13):1589-1591。
[5]Dodds C,Allison J.Postoperative cognitive deficit in the elderly.surgical patient.B rJ A naesth,1998,81:449-462.
[6]Stemmelin J,Cassel JC,Will B,et al.Sensitivity to cholinevgic drag treatment so faged rats with variable degree so fs patial memory impairment.B ebavB rainR es,1999,9 8:5366.
[7]Feldman SA.A comparative study off our premedications.Anaesthesia,1963,18:169-184.
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