【作者】 肖春红；

【导师】 郭素香；

【作者基本信息】 石河子大学 ， 麻醉学， 2011， 硕士

【摘要】 目的：探讨椎管内麻醉与全凭静脉麻醉对中年患者术后认知功能的影响。方法：收集石河子大学医学院第一附属医院2010年3月到2010年8月行非心脏外科手术的中年住院患者(40-59岁)100例,依据手术和病情需要分为全凭静脉麻醉组(TIVA)50例和椎管内麻醉组(IA)50例。分别于术前1天(T1)、术后3天(T2)、30天(T3)行认知功能测定,同期中年健康志愿者50例作为对照组(CG)。详细记录患者的一般资料、术中麻醉用药情况和各项生命体征变化,及术后不良情况等。采用Z计分法对认知功能进行诊断,应用SPSS17.0统计软件进行分析。结果：1. T2时,全麻组出现认知功能障碍5例(10%),椎管内麻醉组2例(4%),对照组1例(2%)。经卡方检验,不同组间认知功能障碍的发生率差异没有统计学意义(x2=3.358,P>0.05)。全麻组、椎管内麻醉组和对照组中认知功能受损的发生率分别为34%(17/50),26% (13/50)和10% (5/50)。与对照组比较,全麻组和椎管内麻醉组认知功能受损病例明显增高,差异有统计学意义(P=0.004,0.037),而全麻组和椎管内麻醉组之间差异无统计学意义(P>0.05)。2. T3时,全麻组出现认知功能障碍3例(6%),椎管内麻醉组出现1例(2%),对照组出现1例(2%)。经卡方检验,不同组间认知功能障碍的发生率差异没有统计学意义(x2=1.088,P>0.05)。全麻组、椎管内麻醉组和对照组中认知受损的发生率分别为24% (12/50),8% (4/50)和6% (3/50)。与对照组比较,全麻组认知功能受损病例增高明显,差异有统计学意义(P=0.012),全麻组与椎管内麻醉组认知受损发生率比较差异有统计学意义(P=0.029),椎管内麻醉组认知受损的例数明显比全麻组的少,对照组与椎管内麻醉组之间差异无统计学意义(P>0.05)。3. T3和T2比较,全麻组和椎管内麻醉组认知功能障碍发生率稍降低,但无统计学意义(P>0.05)；全麻组认知受损的例数减少,但差异无统计学意义(P>0.05)；椎管内麻醉组认知受损的例数明显降低,差异有统计学意义(x2=50741,P=0.017)。4.焦虑自评量表得分显示：与对照组比较,全麻组、椎管内麻醉组间差异均无统计学意义(P>0.05)。结论：中年患者,在全身麻醉或椎管内麻醉下手术后,术后3天可能会影响注意力、记忆力等认知功能,可出现其中一项认知功能受损,但并不能导致POCD的发生。术后30天,椎管内麻醉组大部分认知受损的患者已恢复至术前水平,全麻组较椎管麻醉组认知受损发生率明显增高。说明全麻组对认知功能的作用时间比椎管麻醉组的长。更多还原

【Abstract】 Object:To investigate the influence of cognition function in middle-aged after surgery under two methods of anesthesia—total intravenous anesthesia vs intraspinal anesthesia.Methods:100 ASAⅠ～Ⅱpatients aged 40～59 years undergoing elective surgery in the First Affiliated Hospital of Medical School, Shi he zi University from March 2010 to September 2010 were enrolled. According to operative demand and pathogenetic condition, 50 patients were scheduled for total intravenous anesthesia and 50 patients undergoing intraspinal anesthesia. Cognitive function was assessed at three time points:at 1 day before (T1, at base line) and at 3 days (T2),30 days (T3) after surgery for all patients. Cognitive performance of patients was compared with that of 50 aged-matched healthy controls who were also subjected to repeat the same cognitive measurements 3 days and 30 days apart. Record the general data, anesthetics, vital sign of patients in full.Postoperative cognitive dysfunction was defined by the Z-score analysis. We analyzed the data by statistics Software 17.0.Results:At 3 days after operation, postoperative cognitive dysfunction was detected 5 cases, as 10% of general anesthesia group. the incidence of control group and intraspinal anesthesia group were respective 4% (2/50),2%(1/50). Chi-square test discovered that there were no significant differences among three groups (χ2=3.385, P>0.05). The incidence of postoperative cognitive impairment of control groups is 10%(5/50), while 34%(17/50) and 26%(13/50) in general anesthesia and intraspinal anesthesia. Compared with control objects, cases of postoperative cognitive impairment in other two groups obviously raised (P=0.004, 0.037). There was no significance difference while general anesthesia and intraspinal anesthesia are compared (P>0.05)At 30 days after operation, postoperative cognitive dysfunction was detected 3 cases, as 6% of general anesthesia group. the incidence of control group and intraspinal anesthesia group were respective 2%(1/50),2%(1/50). Chi-square test discovered that there were no significant differences among three groups (χ2=1.088, P>0.05). The incidence of postoperative cognitive impairment of control groups is 6%(3/50), while 24%(12/50) and 6%(3/50) in general anesthesia and intraspinal anesthesia. Compared with control objects, cases of postoperative cognitive impairment in the general anesthesia group obviously raised (P=0.012). There was significance difference while general anesthesia and intraspinal anesthesia are compared (P=0.029)There was no significance difference while control groups and intraspinal anesthesia are compared (P>0.05)At 30 days, compaired with 3 days.The incidence of postoperative cognitive function of general anesthesia group and intraspinal anesthesia group decreased. But there was no significance difference (P>0.05). The incidence of postoperative cognitive impairment of general groups were cut down. But there was no significance difference (P>0.05). The incidence of postoperative cognitive impairment of intraspinal groups depressed obviously, there was no significance difference (χ2=50741, P=0.017))With respect to anxious symptoms, There were no significant differences among the three groups (P>0.05).Conclusion:At 3 days After operation in general anesthesia and intraspinal anesthesia, they can result in early postoperative cognitive impairment for all middle-aged patients, there was no significance difference of the influence of postoperative cognitive dysfunction. Postoperative cognitive impairment had basically recovered in 30 days after operation in intraspinal anesthesia group. To consider the recovery of postoperative cognitive function, intraspinal anesthesia is better than general anesthesia.更多还原