全麻与局麻对老年髋关节手术患者麻醉术后认知功能的影响  

Impact of General Anesthesia and Local Anesthesia on Postoperative Cognitive Function of Elderly Patients after Hip Surgery

作　　者：龙家棋 梁敏[1] 罗春丽[1] 莫坚 

机构地区：[1]广东省廉江市人民医院麻醉科,广东湛江524400 [2]广东医科大学附属医院麻醉科,广东湛江524023

出　　处：《临床医学工程》2017年第7期937-938,共2页Clinical Medicine & Engineering

基　　金：湛江市科技攻关计划项目(项目编号2016B01034)

摘　　要：目的比较全麻与局麻对老年髋关节手术患者麻醉术后认知功能的影响。方法选取64例行髋关节手术的老年患者,其中采用局麻与全麻各32例,分为阳性组(发生POCD)和阴性组(未发生POCD)。比较患者术后第1天、第3天的P300及N400参数。结果与阴性组比较,阳性组术后第1天、第3天的P300及N400潜伏期明显延长(P<0.05),而波幅明显缩短(P<0.05);术后第1天及第3天,阴性组的词条匹配率均显著高于阳性组(P<0.05),且阳性组术后第3天的词条匹配率显著高于第1天(P<0.05)。结论与全麻比较,局麻患者的POCD发生率更低,因此骨科医师选择麻醉方式时应充分考虑POCD发生率;P300及N400的潜伏期延长及其波幅下降提示患者发生POCD的可能性更大,男性、肥胖及脑血管病病史是发生POCD的危险因素,故术前谈话时需向家属强调POCD的可能性。Objective To compare the effects of general anesthesia and local anesthesia on postoperative cognitive function of elderly patients after hip surgery. Methods 64 cases of elderly patients undergoing hip surgery were selected and given local anesthesia （32 cases） and general anesthesia （32 cases） respectively. Patients were divided into positive group （with POCD） and negative group （without POCD）. The P300 and N400 on the first and third day after surgery were compared. Results The first and third day after surgery, the latency of P300 and N400 of positive group were significantly longer than those of negative group （P 〈0.05）, and the amplitude were significantly shorter than those of negative group （P 〈0.05）. The first and third day after surgery, the vocabulary entry matching rates of negative group were significantly higher than those of positive group （P〈0.05）. In positive group, the vocabulary entry matching rate on the third day after surgery was significantly higher than that on the first day after surgery （P〈0.05）. Conclusions Compared with general anesthesia, the incidence of POCD in patients with local anesthesia is lower, so orthopedic doctors should take better account of incidence of POCD in the choice of anesthesia. The prolonged latency of P300 and N400 and decreased amplitude suggests that the probability of POCD is greater. Male, obesity and medical history of cerebrovascular disease are risk factors for POCD. So the probability of POCD needs to be emphasized to family members in preoperative conversation.

关 键 词：麻醉方式 髋关节手术 术后认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]