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目的探讨硬脊膜外阻滞麻醉或全身麻醉方式对老年肺癌患者围手术期认知功能的影响。方法将93例60岁以上需择期行肺癌根治术的患者根据麻醉方式分为硬脊膜外阻滞麻醉组(观察组,46例)和全身麻醉组(对照组,47例),采用简明精神状态量表(MMSE)评估患者术前1 d、术后6 h、术后1、3、7 d的认知功能,并检测患者术前10 min、术毕30 min、术后1 d及术后3 d血清S100-β蛋白水平。结果不同的麻醉方式及术后不同时间,患者的MMSE评分差异有统计学意义,且麻醉方式和术后时间之间存在交互效应;术后6 h两组患者的MMSE评分均出现明显下降趋势(观察组:P=0.000;对照组:P=0.000);对照组术后6 h及术后1 d的MMSE评分均明显低于观察组(6 h:P=0.003;术后1 d:P=0.007);观察组术后6 h发生术后认知功能障碍(POCD)的比例明显低于对照组(13.0%vs 31.9%,P=0.030)。术后不同时间患者血清S100-β蛋白水平有显著差异,术后30 min两组患者的血清S100-β蛋白水平相比术前10 min均出现明显升高(观察组:P=0.010;对照组:P=0.000),但两组间血清S100-β蛋白水平在术后不同时点无明显差异。结论硬脊膜外阻滞麻醉方式对老年肺癌患者的术后认知功能影响较轻,患者POCD发生率低,术后认知功能恢复较快。
Objective To investigate the effect of epidural anesthesia or general anesthesia on cognitive function in elderly patients with lung cancer during perioperative period. Methods Ninety-three patients who underwent radical resection of lung cancer over the age of 60 were divided into epidural anesthesia group (observation group, 46 cases) and general anesthesia group (47 cases), according to the mode of anesthesia. The MMSE was used to evaluate the cognitive function of the patients at 1 d before operation, 6 h after operation, and 1, 3, 7 d after operation. The patients’ cognitive function was detected at 10 min before operation, 30 min after operation, Serum S100-β protein level after 3 days. Results There were significant differences in MMSE scores between different anesthesia methods and postoperative time, and there was an interaction between anesthesia and postoperative time. The MMSE scores of both groups decreased significantly (P = 0.000; control group: P = 0.000). MMSE scores of the control group at 6 h and 1 d after operation were significantly lower than those in the observation group (6 h: P = 0.003; 0.007). The incidence of postoperative cognitive impairment (POCD) in observation group at 6 hours after operation was significantly lower than that in control group (13.0% vs 31.9%, P = 0.030). Serum S100-βprotein levels were significantly different at different time points after operation, and the levels of S100-βprotein in the two groups were significantly increased at 10 min after operation (observation group: P = 0.010; control group : P = 0.000). However, there was no significant difference in serum S100-βprotein levels between the two groups at different time points after operation. Conclusion The method of epidural anesthesia has little effect on postoperative cognitive function in elderly patients with lung cancer. The incidence of POCD is low and the recovery of cognitive function is fast.