Papaioannou A, Fraidakis O, Michaloudis D, Balalis C, Askitopoulou H
University Hospital of Heraklion, Department of Anaesthesiology, Crete, Greece.
Eur J Anaesthesiol. 2005 Jul;22(7):492-9. doi: 10.1017/s0265021505000840.
Postoperative confusion and delirium is a common complication in the elderly with a poorly understood pathophysiology. The aim of this study was to examine whether the type of anaesthesia (general or regional) plays a role in the development of cognitive impairment in elderly patients during the immediate postoperative period.
Forty-seven patients > 60 yr of age and undergoing major surgery were randomly allocated to receive either regional or general anaesthesia. The mental status of the patients was assessed preoperatively and during the first three postoperative days with the Mini Mental State Examination. The incidence of delirium was also examined during the same period with the use of DSM III criteria.
Overall, during the first three postoperative days, the mean Mini Mental State Examination score decreased significantly (P < 0.001). However, this decline was very significant only in patients assigned to receive general anaesthesia (P < 0.001) compared to regional anaesthesia. Nine patients developed delirium but the type of anaesthesia did not affect its incidence. The only important factor for the development of delirium was preexisting cardiovascular disease irrespective of anaesthesia type (P < 0.025).
Elderly patients subjected to general anaesthesia displayed more frequent cognitive impairment during the immediate postoperative period in comparison to those who received a regional technique.
术后谵妄是老年人常见的并发症，其病理生理学机制尚不清楚。本研究旨在探讨麻醉方式（全身麻醉或区域麻醉）是否在老年患者术后早期认知功能障碍的发生中起作用。
47例年龄>60岁且接受大手术的患者被随机分配接受区域麻醉或全身麻醉。术前及术后前三天使用简易精神状态检查表评估患者的精神状态。同时使用《精神疾病诊断与统计手册》第三版标准检查谵妄的发生率。
总体而言，术后前三天，简易精神状态检查表的平均得分显著下降（P<0.001）。然而，与区域麻醉相比，这种下降仅在接受全身麻醉的患者中非常显著（P<0.001）。9例患者发生谵妄，但麻醉方式不影响其发生率。谵妄发生的唯一重要因素是既往心血管疾病，与麻醉方式无关（P<0.025）。
与接受区域麻醉技术的老年患者相比，接受全身麻醉的老年患者在术后早期出现认知功能障碍的频率更高。
