不同麻醉方法对老年患者髋关节置换术术后认知功能障碍的影响  

Effects of Different Anesthesia Methods on the Cognitive Dysfunction of Elder Patients after Hip Replacement Operation

作　　者：郭晓丽[1] 蒋敏[1] 李海波[1] 田永刚[1] 梁立秋[1] 

机构地区：[1]哈尔滨医科大学附属第二临床医院ICU-D,黑龙江哈尔滨150086

出　　处：《现代生物医学进展》2016年第26期5106-5108,5112,共4页Progress in Modern Biomedicine

基　　金：黑龙江省自然科学基金项目(D200821)

摘　　要：目的:比较全身麻醉和硬膜外麻醉两种麻醉方法对老年患者髋关节置换术术后发生认知功能障碍的影响并探讨其可能机制。方法:选择ASAⅡ-Ⅲ级行髋关节置换术的老年患者80例,随机分为全身麻醉组(GA)和硬膜外麻醉组(EA)。采用简易精神状态检查量表法(MMSE)评估两组患者术前1天、术后1天、术后5天的神经精神功能状态。采用酶联免疫吸附试验(ELISA)法检测和比较患者术前1天、术后1天、术后5天血清Aβ和tau蛋白水平。结果:GA组术后1天MMSE评分、血清Aβ蛋白和tau蛋白表达均较术前1天、术后5天明显降低(P<0.05);EA组三个时间点相互比较无统计学差异。EA组T2时间点MMSE评分、血清Aβ蛋白和tau蛋白表达显著高于GA组(P<0.05)。发生POCD的患者Aβ蛋白和tau蛋白表达水平均较非POCD患者明显升高(P<0.05)。结论:硬膜外麻醉能明显降低行髋关节置换术老年患者术后POCD的发生,可能与减少Aβ蛋白和Tau蛋白的表达有关。Objective： To compare the effect of general anesthesia and epidural analgesia on the occurrence of POCD in elderly patients after hip replacement and investigate the possible mechanisms. Methods： Eighty elderly patients undergoing hip replacement were enrolled in this study and were divided into the general anesthesia （GA） and epidural analgesia （EA） group. The minimum mental state examination （MMSE） method was performed to assess the nervous and mental function （POCD）. The Aβ and tau protein levels in blood were detected by using the ELISA assay. Results： Epidural analgesia decreased the MMSE scoring compared to general analgesia （P〈0.05）. General analgesia enhanced the Aβ and tau level compared to epidnral analgesia （P〈0.05）. Aβ and tau levels were increased in the patients with POCD. The POCD occurrence rate in GA group was significantly higher compared to EA group （P〈0.05）. Conclusions： The epidural analgesia method was better than general analgesia method for the elderly patients undergoing hip replacement. POCD might be caused by the enhancement of serum Aβ and Tau protein.

关 键 词：全身麻醉 硬膜外麻醉 术后认知功能障碍 简易精神状态检查量表 

分 类 号：R687[医药卫生—骨科学] R614[医药卫生—外科学]