全身麻醉复合硬膜外麻醉对老年男性患者术后早期认知功能的影响  

The Effect of General Anesthesia Combined with Epidural Anesthesia for Earlier Period POCD in OlderMale Patients

作　　者：田阿勇[1] 王以亮 马虹[1] 

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中国医科大学学报》2014年第3期252-254,共3页Journal of China Medical University

基　　金：辽宁省科学技术计划(2012225021-73)

摘　　要：目的研究复合硬膜外麻醉对老年胸科手术患者术后早期认知功能的影响。方法选择ASAⅠ～Ⅱ级、60～75岁择期全麻下胸科手术的男性患者60例。随机分为A组（全身麻醉复合硬膜外麻醉）和B组（常规全身麻醉），每组30例。常规全身麻醉为术前用药长托宁0．5mg静脉注射，麻醉诱导采用咪达唑仑0．03mg／kg、舒芬太尼0．3～0．5μg／kg、罗库溴铵0．6mg／kg、依托咪酯0．3mg／kg缓慢静注，气管插管后接麻醉机行机械通气。麻醉维持采用持续泵注丙泊酚，吸入七氟烷，间断静注罗库溴铵、舒芬太尼维持。术终均给予托烷司琼5mg静注预防恶心呕吐。术中应用多功能监测仪连续监测血压、心率、心电图、脉搏血氧饱和度、脑电双频指数（BIS）。记录术前及术后3hMMSE评分。结果2组老年男性患者术后认知功能障碍发生率分别为31％和29％，术前及术后MMSE评分组内比较差异有统计学意义（P〈0．05）。术后MMSE评分组间比较差异无统计学差异（P〉0．05）。结论复合硬膜外麻醉不增加老年患者术后早期认知功能障碍的风险。Objective To observe the effect of general anesthesia combined with epidural anesthesia for earlier period postoperafion cognitive dys- function （POCD） in older male patients. Methods 60 ASA Ⅰ- Ⅱ male thoracic surgery patients aged 60-75 years under general anesthesia were en- rolled in this study. Body weight were normal. The patients were randomly assigned to two study groups ： group A received general anesthesia com- bined with epidural anesthesia, group B received general anesthesia.Anesthesia was induced with midazolam, sufentanyl, rocuronium, propofol, and maintained with inhalate sevoflurane and intravenous propofol. The MMSE scores were observed for the preoperative and postoperative 3 h. Results The incidences of POCD were 31% and 29% for older male patients among group A and B, there is difference of statistics for the MMSE scores be- tween the preoperative and postoperative （P 〈0.05）. There is no difference with the postoperative between two groups （P 〉 0.05）. Conclusion General anesthesia combined with epidural anesthesia was to utilized safely for older male patients that it did not raise the risk of earlier period POCD.

关 键 词：全身麻醉复合硬膜外麻醉 老年 术后认知功能障碍 

分 类 号：R614.2[医药卫生—麻醉学]