腹腔镜胆囊切除术患者行全麻复合硬膜外麻醉的效果及对术后早期认知功能的影响
[摘要] 目的 探讨腹腔镜胆囊切除术患者行全麻复合硬膜外麻醉的效果及对术后早期认知功能的影响。方法 方便收集该院自2015年6月—2017年7月收治的接受腹腔镜胆囊切除术治疗的患者120例作为观察对象，按随机数字表法分为观察组与对照组，每组60例。对照组给予全麻，观察组则给予全麻复合硬膜外麻醉。观察并对比两组麻醉效果情况。结果 术前，两组在简易智能量表（MMSE）评分上对比差异无统计学意义（P>0.05）；术后2 h，对照组的各项MMSE评分明显低于术前（P<0.05），观察组的注意力及计算力MMSE评分为（4.09±0.64）分，语言能力评分为（8.19±1.10）分，回忆能力评分为（2.29±0.21）分，记忆力评分为（2.19±0.25）分，虽然略低于术前，但前后对比差异无统计学意义（P>0.05）。结论 针对接受腹腔镜胆囊切除术治疗的患者，手术过程中实施全麻复合硬膜外麻醉具有满意的效果，对患者术后的早期认知功能影响小，术后恢复快，具有较高的推广价值。
[关键词] 腹腔镜胆囊切除术；全麻复合硬膜外麻醉；认知功能
[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2018）01（c）-0001-03
[Abstract] Objective This paper tries to investigate the effect of general anesthesia combined with epidural anesthesia in laparoscopic cholecystectomy and the effect of early postoperative cognitive function. Methods 120 cases of patients with laparoscopic cholecystectomy were conveient selected in this hospital from June 2015 to July 2017. The patients were divided into two groups according to the random number table method： the observation group and the control group， each group of 60 cases. The control group was given general anesthesia， the observation group was given general anesthesia combined with epidural anesthesia. The anesthesia effect of the two groups were observed and compared. Results There was no significant difference between the two groups in the simple intelligence scale （MMSE） score before operation （P>0.05）. The MMSE score of the control group of 2 hours after surgery was significantly lower than the preoperative（P<0.05）. The observation group’s attention and computational power MMSE score was （4.09±0.64）points， the language proficiency score was （8.19±1.10） points， the recall score was （2.29±0.21）points， the memory score was （2.19±0.25） points， although slightly lower than the preoperative， the difference was not statistically significant before and after the surgery（P>0.05）. Conclusion For patients undergoing laparoscopic cholecystectomy， the effect of general anesthesia combined with epidural anesthesia during the operation was satisfactory， and effect on the early cognitive function was small and the postoperative recovery was quick， with a high promotion value.
[Key words] Laparoscopic cholecystectomy； General anesthesia combined epidural anesthesia； Cognitive function
現阶段，因腹腔镜胆囊切除术具有微创、可保留患者胆囊功能，加上术后并发症少等优势而被临床广泛应用于胆囊疾病的治疗中[1-2]。早期临床上在手术的过程中通常给予全凭静脉麻醉，虽然能够通过抑制中枢神经系统来达到镇静及镇痛的效果，但手术操作、术中建立气腹等因素可通过躯体神经与交感神经的上行传导来引起创伤反应，导致早期认知功能差[3-4]。硬膜外麻醉是临床上较为常用的一种椎管内麻醉手段，在留置导管之后可以在术中追加给药，对躯体神经及交感神经的信号传导具有理想的阻滞作用[5]。该院自2015年6月—2017年7月将全麻复合硬膜外麻醉引入到了60例接受腹腔镜胆囊切除术患者的治疗中，取得了满意的效果，现报道如下。