| 潘华,王海丽,杨爱玲,屈海波.多模式预处理预防老年人术后认知功能障碍[J].浙江中西医结合杂志,2021,31(11): |
| 多模式预处理预防老年人术后认知功能障碍 |
| Multi-mode preconditioning to prevent postoperative cognitive dysfunction in the elderly |
| 投稿时间：2021-06-10 修订日期：2021-09-29 |
| DOI： |
| 中文关键词: 老年患者 术后认知功能障碍 多模式组 |
| 英文关键词:elderly patients postoperative cognitive dysfunction multi-mode pretreatment |
| 基金项目:三门峡市科技局立项，项目编号：2016030312 |
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| 中文摘要: |
| 目的 探讨多模式预处理对老年腰椎术后患者认知功能障碍的预防作用。方法 120例行腰椎内固定手术的患者，随机分为3组，对照组（A组，n=40）和全凭静脉麻醉组（B组，n=40），多模式组（C组，n=40），A组常规静吸复合麻醉，B组全凭静脉麻醉，C组在全凭静脉麻醉基础上辅以右旋美托咪定维持，连接BIS监测麻醉深度，以FloTrac／Vigileo系统指导目标靶控输液，术后接静脉镇痛泵。三组患者均于麻醉前10min、术后12 h、术后24 h采血测定血浆S100B浓度，于术前1天，术后第4天行MMSE评分并统计POCD 的发生率，记录患者术后并发症(高血压或低血压，心动过缓或心动过速)、住院时间以及住院费用、患者满意度。结果 3组患者S100B浓度在术后12h及24h均较术前增高，与A、B组比较，C组术后S100B浓度降低；术后MMSE评分均较术前降低，与A、B组比较，C组术后MMSE评分较高，术后并发症及POCD发生率降低，患者满意度较高，住院时间较短，住院费用降低。结论 多模式预处理对老年患者术后认知功能障碍有一定的预防作用，值得推广。 |
| 英文摘要: |
| 【Abstract】
Objective To investigate the preventive effect of multi-mode pretreatment on postoperative cognitive dysfunction in elderly patients after lumbar surgery.
Methods 120 patients undergoing lumbar internal fixation surgery were randomly divided into 3 groups: control group (group A, n=40) and total intravenous anesthesia group (group B, n=40), multimodal group (group C, n =40). Group A was performed with Inhalation combined anesthesia, and group B with intravenous anesthesia. Group C was supplemented with dexmedetomidine for anesthesia on the basis of total intravenous anesthesia，and BIS was used to monitor the depth of anesthesia，and The FloTrac/Vigileo system was used to guide intraoperative infusion, Patient control intravenous analgesia (PCIA) was used for postoperative analgesia. Plasma S100B concentration was measured in all three groups of patients at 10 minutes before anesthesia, 12 and 24 hours after surgery. The MMSE score was calculated 1 day before surgery and the 4th day after surgery. and the incidence of POCD was counted. Postoperative complications (hypertension or hypotension, bradycardia or tachycardia), length of hospital stay, hospitalization costs, and patient satisfaction were recorded respectively.
Results The concentrations of S100B were higher than those before operation at 12h and 24h in all the three groups. Compared to the group A and B, the concentration of S100B was lower in group C. Postoperative MMSE score lower than before surgery. Compared to group A and group B, group C had higher MMSE score after operation and the postoperative complications and POCD rate were lower, the patient satisfaction was higher, the hospital stay was shorter, and the hospitalization cost was lower.
Conclusion Multi-mode pretreatment has a preventive effect on postoperative cognitive dysfunction in elderly patients, which is worthy of promotion. |
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