Effect of Conbinated of General Anesthesia and Epidural Anesthesia on Early Postoperative cognitive Dysfunction in Eder
YU Jie， QI Xue-fen
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Department of anesthesiology， Kecheng district people hospital， Quzhou 324000， China
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收稿日期
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出版日期
2011-11-11
2011-11-11
2011-08-15
发布日期
2011-08-15
摘要
目的 探讨全麻复合硬膜外麻醉对老年患者上腹部大手术术后认知功能障碍(postoperative cognitive dysfunction， POCD)的影响。方法 选择ASA Ⅰ～Ⅲ级，65岁以上择期行上腹部手术患者55例，随机均分为异氟醚全麻组(27例，G组)与异氟醚全麻合并硬膜外麻醉组(28例，C组)。G组常规诱导麻醉后，吸入异氟醚，间断静脉给予维库溴铵、芬太尼维持麻醉。C组吸入异氟醚(呼气末浓度为1.2％～1.5％，MAC维持在0.7～0.8，术中每间隔45 min于硬膜外导管内注入0.5％盐酸罗哌卡因3～4 mL，维库溴铵0.03 mg·kg-1维持肌松，分别于术前24 h、术后1、3、5 d采用简化智能评分(mini-metal state examination， MMSE)评估认知功能，并计算出Z值，Z≥2分判断患者。在相应时点抽取静脉血，离心提取血清，采用免疫酶联吸附法(ELISA)测定S100β浓度。结果 两组患者术前MMSE评分、S100β蛋白测定值比较无差异。术后各时间点血清S100β浓度G组均较C组高(P<0.05)。术后1、3 d C组POCD发生率显著低于G组(P<0.05)；术后5 d POCD发生率两组无显著差异(P>0.05)。结论 全麻联合硬膜外麻醉可显著降低老年患者上腹部手术血清中S100β浓度与近期POCD发病率。
Abstract
OBJECTIVE To compare the effects of genera1 anesthesia versus combined epidural and general anesthesia on early postoperative cognitive dysfunction(POCD) in elderlies. METHODS Sixty patients aged 70-88 years, scheduled for elective upper abdominal surgery with ASA Ⅰ-Ⅲ, were randomly divided into general anesthesia group(group G, n=27) and combined epidural and genera1 anesthesia group(group C, n=28), and received genera1 anesthesia with tracheal intubation and thoracic epidural blockade with 0.375% ropivacaine, , respectively. POCD was assessed by mini-metal state examination(MMSE) and serum S100β levels at 24 h before operation, 1, 3 and 5 d after operation respectively. Z value was used to analyze the data. POCD was defined as Z value ≥ 2. RESULTS There was no significant difference between the preoperative MMSE and serum S100β levels of the the two groups. At 1 d after surgery, POCD incidences were 16(59.2%) in group G and 10(35.7 %) in group C(P<0.05). At 3 d after surgery, POCD was present in 9(33.3%) in group G and 6(21.2%) in group C(P<0.05). CONCLUSION When applied to major abdominal surgery, combined general anesthesia and thoracic epidural blockade can decrease POCD incidence and serum S100β levels compared with general anesthesia.
YU Jie;QI Xue-fen.
Effect of Conbinated of General Anesthesia and Epidural Anesthesia on Early Postoperative cognitive Dysfunction in Eder[J]. Chinese Pharmaceutical Journal, 2011, 46(16): 1286-1288
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参考文献
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