不同麻醉老年患者术后认知功能障碍情况比较研究  

A comparative study of different narcotic postoperative cognitive dysfunction in elderly patients

作　　者：余鸭全 陈永伦[1] 邓玫[1] 

机构地区：[1]云南省曲靖市第一人民医院麻醉科,云南曲靖655000

出　　处：《世界最新医学信息文摘》2014年第3期9-10,共2页World Latest Medicine Information Electronic Version

摘　　要：目的：针对不同麻醉老年患者术后认知功能障碍的状况进行研究和分析。方法从我院2010年1月至2013年12月接收并治疗的人工股骨头置换术患者中随机抽取300例进行回顾性分析，其中男性患者为155例，女性患者为145例，年龄区间在65～89岁之间，平均年龄为74.5岁，体重在46～68kg，通过 asa 分为 ii 级跟 iii 级。并将300例患者随机的分为两组，即全麻组（G 组）150例，脊椎-硬膜外阻滞组（s-e 组）150例。s-e 组中患者采用蛛网膜下腔注射0.5%的罗哌卡因重比重液2ml，时间控制在20s，然后保持原来的体位15分钟，并且要调整患者的麻醉平面，在手术中可以选择性的追加0.5%的罗哌卡因的量，同时在麻醉前的24小时、术后24小时和72小时进行量化功能评分，采用 MMse 量化表，抽取静脉血样并进行血浆β淀粉样蛋白浓度的测定；而 G 组采用的是静脉注射，咪达唑仑为0.1mg/kg，芬太尼3～5μg / kg、异丙酚2mg/kg、维库溴铵0.1 mg / kg 来进行麻醉诱导，并且要将静脉输注的丙泊酚维持在2～3mg＆#183;kg-1＆#183;h-1，维库溴铵0.04mg / kg，芬太尼 l μg / kg，并且要同时吸入1.5%～2.0%的异氟醚，然后比较两组的效果。结果两组患者病例通过采用不同方式进行麻醉处理后，结果显示，s-e 组的患者病例中患者的认知功能的障碍发生率跟血浆β淀粉样蛋白浓度要比 G 组患者中的低，存在明显差异（P ＆lt;0.05）。结论通过采用全麻较脊椎-硬膜外阻滞的方式更易导致老年患者在术后的认知功能障碍。Objective to conduct research and analysis of the situation of the different cognitive dysfunction after anesthesia in elderly patients . Methods from our hospital from January 2011 to december 2012 to receive and treat the hemiarthroplasty patients randomly selected 300 cases were retrospectively analyzed 155 cases of patients were male , 145 female patients , age range at between 65 ~ 89 years, mean age was 74.5 years old , weighing 46-68kg, divided by grade ii with asa class iii . and 300 patients were randomly divided into two groups, namely the general anesthesia group （G group ） 150 cases , spinal - epidural anesthesia group （se group ） 150 cases . se group of patients with subarachnoid injection of 0.5% hyperbaric ropivacaine solution 2ml, time control in 20s, then 15 minutes to maintain the original position , and to adjust the patient＆#39;s anesthesia , the surgery can be selectively an additional amount of 0.5% ropivacaine , and 24 hours before anesthesia , 24 hours and 72 hours after surgery to quantify the functional score , using the MMse quantization table , and venous blood samples were measured in plasma β -amyloid protein concentration ; the group G is used in intravenous midazolam was 0.1mg/kg, fentanyl 3 ~ 5μg/kg, propofol 2mg/kg,, vecuronium 0.1 mg / kg for induction of anesthesia , and to intravenous infusion of propofol was maintained at 2-3mg ＆#183; kg-1 ＆#183; h-1, vecuronium 0.04mg/kg, fentanyl l μg / kg, and inhalation of 1.5% to 2.0% while the isoflurane , and then compare the effect of two groups . Results the two groups of cases by using different ways of anesthesia after treatment showed that patients with disorders of cases se group cognitive function in patients with the incidence than the G protein concentration in plasma β -amyloid in the group of patients is low, the presence of significant difference （P ＆lt;0.05）. Conclusion By using spinal anesthesia compared - epidural approach has resulted in cognitive dysfunction in elderly patients after surgery .

关 键 词：不同麻醉 老年患者 术后认知功能障碍 比较 

分 类 号：R614[医药卫生—麻醉学]