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目的探讨不同麻醉方式对老年肝癌患者行切除术后的认知功能的影响。方法选择2014年9月-2016年9月医院收治的老年肝癌患者120例,随机分为2组,各60例。其中给予对照组全身麻醉,而观察组则运用硬膜外麻醉。观察2组术后认知功能障碍发生率,运用老年人认知功能筛查量表(CASI)和简易智能精神状态量表(MMSE)分别于术后6 h、1 d以及3 d评价2组患者的认知功能;观察术后自主呼吸恢复、定向力恢复时间、睡眠时间及总液体丧失量。结果观察组患者术后认知功能障碍发生率为10.00%(6/60)低于对照组的28.33%(17/60),差异有统计学意义(P<0.05)。与对照组相比,观察组术后6 h、1 d以及3 d的CASI和MMSE评分均较高,差异有统计学意义(P<0.05)。与对照组相比,观察组的术后自主呼吸恢复和定向力恢复时间均较短,差异均有统计学意义(P<0.05),但2组的总液体丧失量和睡眠时间比较无统计学意义(P>0.05)。结论临床上给予老年肝癌切除术患者硬膜外麻醉,不容易影响术后认知功能,有助于恢复神经系统功能。
Objective To investigate the effect of different anesthesia on the cognitive function of elderly patients with hepatocellular carcinoma after resection. Methods A total of 120 elderly patients with hepatocellular carcinoma (HCC) admitted from September 2014 to September 2016 in our hospital were randomly divided into 2 groups (60 in each). The control group received general anesthesia while the observation group received epidural anesthesia. The incidence of postoperative cognitive dysfunction was observed in two groups. The cognitive function screening scale (CASI) and simple mental state scale (MMSE) were used to evaluate the incidence of postoperative cognitive impairment in both groups at 6 h, 1 d and 3 d after operation The cognitive function of patients was observed. The recovery of spontaneous respiration, recovery time of directional force, sleep time and total fluid loss were observed. Results The incidence of postoperative cognitive impairment in the observation group was 10.00% (6/60), which was lower than that in the control group (28.33%, 17/60). The difference was statistically significant (P <0.05). Compared with the control group, CASI and MMSE scores of observation group at 6 h, 1 d and 3 d after surgery were significantly higher (P <0.05). Compared with the control group, postoperative spontaneous breathing recovery and recovery time of the directional force in the observation group were shorter, the difference was statistically significant (P <0.05), but the total liquid loss and sleep time in the two groups were not statistically significant Significance (P> 0.05). Conclusion Epidural anesthesia in elderly patients with liver cancer resection is not easy to affect postoperative cognitive function and help to restore the nervous system function.