目的 观察全麻复合硬膜外麻醉对老年膝关节置换术患者认知功能的影响。方法 选取2015年2月—2019年3月接受膝关节置换术患者80例,根据随机数表法分为观察组及对照组,各40例。对照组实施持续硬膜外麻醉,观察组实施全麻复合硬膜外麻醉,对比两组手术各时点的血流动力学变化情况;术后3 d,采用简易精神状况检查量表（MMSE）评估患者认知功能障碍发生情况。结果 入室前,两组血流动力学各指标比较,差异无统计学意义（P>0.05）。切皮时及骨水泥填充后,两组患者各血流动力学指标均较入室前逐渐下降,但观察组下降幅度不及对照组,即观察组切皮时、骨水泥填充后各血流动力学指标水平均高于对照组,差异有统计学意义（P<0.05）。术后3 d,两组患者认知功能障碍发生率比较差异无统计学意义（P>0.05）。但观察组发生认知功能障碍患者功能障碍程度较对照组轻微,差异有统计学意义（P<0.05）。结论 全麻复合硬膜外麻醉应用于老年膝关节置换术麻醉效果确切,对患者的血流动力学影响小,可有效减轻对患者术后认知功能的影响,安全可靠。

Objective To observe the effect of general anesthesia combined with epidural anesthesia on cognitive function of elderly patients with knee arthroplasty. Methods Eighty patients who received knee arthroplasty from February 2015 to March 2019 were selected, and according to the random number table method they were divided into an observation group and a control group, with 40 cases in each group. The control group received continuous epidural anesthesia, and the observation group received general anesthesia combined with epidural anesthesia. The hemodynamic changes at different time points during operation were compared between the two groups. The Mini Mental State Examination （MMSE） scale was used to assess the occurrence of cognitive dysfunction in the patients. Results Before entering the operation room, there was no significant difference in hemodynamic indicators between the two groups （P>0.05）; during skin incision and after bone cement filling, the hemodynamic indicators of patients in both groups were decreased gradually compared with those before, but the reduction in the observation group was smaller than that in the control group, namely the hemodynamic indicators in the observation group were higher than those in the control group （P<0.05）. At 3 days after operation, no difference was found in the incidence rate of cognitive dysfunction between the two groups （P>0.05）; but the degree of cognitive dysfunction in the observation group was slighter than that in the control group （P<0.05）. Conclusion General anesthesia combined with epidural anesthesia has a definite effect for elderly patients with knee arthroplasty, which has little influence on hemodynamics and postoperative cognitive function, and is safe and reliable.