麻醉方式对老年膝关节置换术患者术后认知功能影响  

Anesthesia methods effect on postoperative cognitive function in elderly patients undergoing knee arthroplasty

作　　者：钱江洁[1] 林伟利[1] 徐旭仲[2] 

机构地区：[1]温州医科大学附属第三医院,温州325200 [2]温州医科大学附属第一医院

出　　处：《浙江创伤外科》2016年第2期216-218,共3页Zhejiang Journal of Traumatic Surgery

摘　　要：目的观察麻醉方式对老年膝关节置换术患者术后认识功能的影响,为临床麻醉提供参考。方法选取本院收治老年膝关节置换术患者150例为研究对象,随机分为观察组和对照组,对照组全麻,观察组腰硬联合麻醉。观察患者认知功能变化,并比较患者各指标变化。结果术后1天和术后5天,观察组患者MMSE评分均显著高于对照组,P<0.05。术后1天,观察组患者PDCD发生率显著低于对照组,P<0.05;术后5天,观察组患者PDCD发生率低于对照组,但差异不明显,P>0.05。观察组和对照组T1时刻和T3时刻Tau蛋白血清浓度无明显差异,P>0.05;T2时刻,观察组Tau蛋白血清浓度显著低于对照组,P<0.05。POCD组和非POCD组T1时刻和T3时刻Tau蛋白无明显差异,P>0.05;T2时刻,POCD组Tau蛋白血清浓度显著高于非POCD组,P<0.05。结论老年膝关节置换术患者治疗中,采用腰硬联合麻醉方式能够提高认知功能,减少POCD发生率,Tau蛋白浓度升高可能会引起POCD的发生。Objective To observe the anesthesia methods effect on postoperative cognitive function in elderly patients undergoing knee arthroplasty. Methods 150 elderly patients undergoing knee arthroplasty in hospital were selected, randomly divided into observation group and control group. Combined spinal- epidural anesthesia was applied in observation group and general anesthesia in control group. The postoperative cognitive function and clinical index were recorded and analyzed. Results 1 day and 5 days after surgery,MMSE score in the observation group was significantly higher than that in the control group（P〈0.05）. 5 days after surgery, the incidence of POCD in the observation group was significantly lower than that in the control group（P〈0.05）. 5 days after surgery, the incidence of POCD in the observation group was lower than that in the control group, but the difference was not obvious（P〉0.05）. Tau serum protein at T1 and T3 time had no significant difference between the 2 groups（ P〉0.05）.Tau serum protein at T2 time in the observation group was significantly lower than that in the control group（ P 〉0.05）. The concentrations of Tau in POCD group and non-POCD group at T1 and T3time had no significant difference（P 〉0.05）. The serum concentration of Tau protein at T2 time in POCD group was significantly higher than that in the non-POCD group（P 〈0.05）. Conclusion Epidural anesthesia used in elderly patients undergoing knee arthroplasty reduced the incidence of POCD. Tau protein concentration might cause the occurrence of POCD.

关 键 词：麻醉方式 老年膝关节置换患者 认知功能 认知功能障碍 

分 类 号：R614.4[医药卫生—麻醉学]