本文選題：麻醉方法 + 老年��； 參考：《上海醫(yī)學(xué)》2015年10期

【摘要】：目的探討全身麻醉和硬脊膜外腔阻滯麻醉對(duì)老年患者前列腺電切術(shù)(TURP)術(shù)后早期認(rèn)知功能的影響。方法選擇擬行TURP的老年患者60例,年齡66~86歲,美國麻醉醫(yī)師協(xié)會(huì)(ASA)分級(jí)Ⅰ至Ⅲ級(jí)。采用隨機(jī)數(shù)字表法將患者分入全身麻醉組(全麻組)和硬脊膜外腔阻滯麻醉組(硬膜外組),每組30例。在入手術(shù)室后麻醉前10min(T_0)、手術(shù)即刻(T_1)、術(shù)畢即刻(T_2)、術(shù)后20min(T_3)各時(shí)間點(diǎn)記錄患者的平均動(dòng)脈壓(MAP)和心率,記錄手術(shù)時(shí)間、輸液量、膀胱沖洗液量、前列腺質(zhì)量,記錄術(shù)后1d(T4)的疼痛視覺模擬評(píng)分(VAS評(píng)分)和血鈉水平。分別于T_0、T_2和T_4時(shí)間點(diǎn)抽取外周靜脈血3mL,采用ELISA法檢測S-100β蛋白、IL-6和TNF-α水平。分別在術(shù)前和T_4時(shí)對(duì)患者進(jìn)行神經(jīng)心理學(xué)測試,計(jì)算術(shù)后成績與基礎(chǔ)值的差值,記錄術(shù)后認(rèn)知功能障礙(POCD)發(fā)生情況。依據(jù)T_4時(shí)有無POCD,將患者分為POCD組和非POCD組。結(jié)果在累加測試中,全麻組和硬膜外組T_4時(shí)間點(diǎn)的分?jǐn)?shù)顯著低于同組T_0時(shí)間點(diǎn)(P值均0.05),硬膜外組T_0與T_4時(shí)間點(diǎn)差值的絕對(duì)值顯著小于全麻組(P0.05)。在數(shù)字廣度-逆向測試中,全麻組T4時(shí)間點(diǎn)的位數(shù)顯著少于同組T0時(shí)間點(diǎn)(P0.05)。60例患者中,9例(15.0%)發(fā)生POCD(POCD組),51例未發(fā)生POCD(非POCD組)。其中,全麻組發(fā)生POCD 5例(16.7%),硬膜外組4例(13.3%),兩組間POCD發(fā)生率的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。全麻組、硬膜外組、POCD組、非POCD組T2時(shí)間點(diǎn)的S-100β蛋白、IL-6、TNF-α水平和POCD組T_4時(shí)間點(diǎn)的IL-6水平均顯著高于同組T0時(shí)間點(diǎn)(P值均0.05),POCD組T2時(shí)間點(diǎn)的S-100β蛋白、IL-6、TNF-α水平和T4時(shí)間點(diǎn)的IL-6水平均顯著高于非POCD組同時(shí)間點(diǎn)(P值均0.05)。結(jié)論與全身麻醉相比,硬脊膜外腔阻滯麻醉不能降低老年患者TURP術(shù)后POCD發(fā)生率,POCD患者外周血中S-100β蛋白、IL-6和TNF-α水平升高。
[Abstract]:Objective to investigate the effect of general anesthesia and epidural block anesthesia on early cognitive function after TURP in elderly patients. Methods A total of 60 elderly patients, aged 66 to 86 years, were selected for TURP. The ASAs of the American Association of Anesthesiologists were graded 鈪，

本文編號(hào)：2035076