Anwer Hisham M F, Swelem Shafik E, el-Sheshai Adel, Moustafa Ayman A
Faculty of Medicine, Alexandria University.
Middle East J Anaesthesiol. 2006 Oct;18(6):1123-38.
This study compared the effect of general anesthesia or regional vertebral analgesia (subarachnoid or epidural) on postoperative cognitive function in 60 young adult (group A) and 60 elderly (group E) patients undergoing orthopedic and urologic surgery. Wechsler Adult Intelligence Scale-Revised for cognitive functions assessment was done preoperatively, and postoperatively; one day and three days after surgery. Variations in heart rate, blood pressure, arterial oxygen and carbon dioxide tensions, and pH as well as serum bicarbonate, sodium and potassium levels, were assessed at the same time intervals. They did not show any significant change from the preoperative levels. Cognitive functions, one and three days after surgery, did not change significantly in young adult patients after either general or regional vertebral nor in elderly patients who received regional regional vertebral, as compared with the preoperative levels. Only elderly patients who received general anesthesia had significant decline in cognitive function one day after surgery. It significantly improved on the third postoperative day but still was significantly less than the preoperative level. Moreover, significantly better WAIS-R Scores were found in the elderly group one and three days after spinal anesthesia than after general anesthesia. The results indicate that general anesthesia poses a significant risk for the occurrence of early postoperative cognitive dysfunction in elderly patients that can persist for 3 day after surgery. Regional vertebral analgesia is advantageous over general anesthesia for elderly patients in terms of a better postoperative neuropsychological functioning.
本研究比较了全身麻醉或区域椎体镇痛（蛛网膜下腔或硬膜外）对60例接受骨科和泌尿外科手术的年轻成人患者（A组）和60例老年患者（E组）术后认知功能的影响。术前、术后以及术后1天和3天使用韦氏成人智力量表修订版进行认知功能评估。同时评估相同时间间隔内心率、血压、动脉血氧和二氧化碳分压、pH值以及血清碳酸氢盐、钠和钾水平的变化。这些指标与术前水平相比均未显示出任何显著变化。与术前水平相比，年轻成人患者在接受全身麻醉或区域椎体镇痛后，以及老年患者接受区域椎体镇痛后，术后1天和3天的认知功能均未发生显著变化。只有接受全身麻醉的老年患者在术后1天出现认知功能显著下降。术后第3天显著改善，但仍显著低于术前水平。此外，在老年组中，脊髓麻醉后1天和3天的韦氏成人智力量表修订版得分显著高于全身麻醉后。结果表明，全身麻醉对老年患者术后早期认知功能障碍的发生构成显著风险，且这种风险可持续至术后3天。就术后更好的神经心理功能而言，区域椎体镇痛对老年患者比全身麻醉更具优势。
