腹腔鏡膽囊切除術(shù)患者行全麻復(fù)合硬膜外麻醉的效果及對術(shù)后早期認(rèn)知功能的影響

　　[摘要] 目的 探討腹腔鏡膽囊切除術(shù)患者行全麻復(fù)合硬膜外麻醉的效果及對術(shù)后早期認(rèn)知功能的影響。方法 方便收集該院自2015年6月—2017年7月收治的接受腹腔鏡膽囊切除術(shù)治療的患者120例作為觀察對象，按隨機(jī)數(shù)字表法分為觀察組與對照組，每組60例。對照組給予全麻，觀察組則給予全麻復(fù)合硬膜外麻醉。觀察并對比兩組麻醉效果情況。結(jié)果 術(shù)前，兩組在簡易智能量表（MMSE）評分上對比差異無統(tǒng)計(jì)學(xué)意義（P>0.05）；術(shù)后2 h，對照組的各項(xiàng)MMSE評分明顯低于術(shù)前（P<0.05），觀察組的注意力及計(jì)算力MMSE評分為（4.09±0.64）分，語言能力評分為（8.19±1.10）分，回憶能力評分為（2.29±0.21）分，記憶力評分為（2.19±0.25）分，雖然略低于術(shù)前，但前后對比差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 針對接受腹腔鏡膽囊切除術(shù)治療的患者，手術(shù)過程中實(shí)施全麻復(fù)合硬膜外麻醉具有滿意的效果，對患者術(shù)后的早期認(rèn)知功能影響小，術(shù)后恢復(fù)快，具有較高的推廣價(jià)值。
　　[關(guān)鍵詞] 腹腔鏡膽囊切除術(shù)；全麻復(fù)合硬膜外麻醉；認(rèn)知功能
　　[中圖分類號] R4 [文獻(xiàn)標(biāo)識碼] A [文章編號] 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(xiàn)階段，因腹腔鏡膽囊切除術(shù)具有微創(chuàng)、可保留患者膽囊功能，加上術(shù)后并發(fā)癥少等優(yōu)勢而被臨床廣泛應(yīng)用于膽囊疾病的治療中[1-2]。早期臨床上在手術(shù)的過程中通常給予全憑靜脈麻醉，雖然能夠通過抑制中樞神經(jīng)系統(tǒng)來達(dá)到鎮(zhèn)靜及鎮(zhèn)痛的效果，但手術(shù)操作、術(shù)中建立氣腹等因素可通過軀體神經(jīng)與交感神經(jīng)的上行傳導(dǎo)來引起創(chuàng)傷反應(yīng)，導(dǎo)致早期認(rèn)知功能差[3-4]。硬膜外麻醉是臨床上較為常用的一種椎管內(nèi)麻醉手段，在留置導(dǎo)管之后可以在術(shù)中追加給藥，對軀體神經(jīng)及交感神經(jīng)的信號傳導(dǎo)具有理想的阻滯作用[5]。該院自2015年6月—2017年7月將全麻復(fù)合硬膜外麻醉引入到了60例接受腹腔鏡膽囊切除術(shù)患者的治療中，取得了滿意的效果，現(xiàn)報(bào)道如下。

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