Maurette P, Castagnera L, Vivier C, Erny P
Département d'Anesthésie-Réanimation I, Groupe Hospitallier Pellegrin, Bordeaux.
Ann Fr Anesth Reanim. 1988;7(4):305-8. doi: 10.1016/s0750-7658(88)80033-9.
Although worsening cerebral function in the elderly is often said to be due to anaesthesia, it still remains to be proved that anesthesia acts on an elderly patient's psychological make-up. This study aimed to compare the psychological effects of general or spinal anaesthesia on 35 patients more than 70-yr old under repair of a subcapital femoral fracture, after having excluded 63 patients. They were randomly divided into two groups, the first receiving a spinal anaesthetic with 1.5 mg.kg-1 prilocaine (RA; n = 19), and the others a general anaesthetic with 5 mg.kg-1 thiopentone, dextromoramide, nitrous oxide and enflurane (GA; n = 16). None of the patients wer given a premedication. They underwent a battery of six psychological tests before and 36 h after surgery, all carried out by the same physician. Six patients in GA group and three in RA group developed a transient fall in mean blood pressure just after anaesthetic induction (not significant). There were no significant differences between the two groups in age, sex distribution, ASA class and performance in the tests, both before and after surgery. Individual psychological scores did not differ either. In the RA group, the postoperative tests were even better carried out than before surgery (p less than 0.05). It could therefore be concluded that anaesthesia alone has little impact on the psychological status of elderly patients.
虽然人们常说老年人脑功能恶化是由于麻醉所致，但麻醉是否作用于老年患者的心理构成仍有待证实。本研究旨在比较全身麻醉或脊髓麻醉对35例70岁以上股骨颈骨折修复患者的心理影响，此前已排除63例患者。他们被随机分为两组，第一组接受1.5mg·kg-1丙胺卡因的脊髓麻醉（RA组；n = 19），另一组接受5mg·kg-1硫喷妥钠、右吗拉胺、氧化亚氮和恩氟烷的全身麻醉（GA组；n = 16）。所有患者均未给予术前用药。在手术前和术后36小时，他们接受了一系列六项心理测试，所有测试均由同一位医生进行。GA组有6例患者和RA组有3例患者在麻醉诱导后即刻出现平均血压短暂下降（无统计学意义）。两组在年龄、性别分布、ASA分级和手术前后测试表现方面均无显著差异。个体心理评分也没有差异。在RA组，术后测试甚至比手术前完成得更好（p < 0.05）。因此可以得出结论，单纯麻醉对老年患者的心理状态影响很小。
