青少年脊柱侧凸矫形术后认知功能障碍的临床研究  

Clinical study of cognitive dysfunction after scoliosis orthopedics in adolescent

作　　者：郑旭[1] 孙玉娥[1] 彭慧萍[1] 顾小萍[1] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《国际麻醉学与复苏杂志》2013年第11期977-981,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金资助项目（30872439/81171047/81070892）;江苏省卫生厅课题（RC2011006/XK201140/H200943）

摘　　要：目的观察青少年脊柱侧凸矫形手术患者术后认知功能障碍（postoperative cognitive dysfunction，POCD）的发生率。方法拟选入择期行脊柱后路矫形手术患者52例，美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，年龄11岁～18岁。根据术后7d是否发生POCD，将患者分为非POCD组和POCD组。术前1d、术后7d均采用简易智能评估量表（mini-mental state examination，MMSE）、视觉词语学习测验、stroop色词命名测验、数字广度测试、连线测验以及数字符号测验综合评估患者的认知功能状态，记录患者的年龄、性别、受教育年限、既往病史、术前1d及术后1、3d视觉模拟评分（visu alanalog scale，VAS）及术后并发症，进行统计分析。结果1例患者因术前MMSE评分为21分被剔除，其余51例完成测试。根据诊断标准，15例患者在术后7d发生POCD，即POCD发生率为29．4％，经统计，视觉词语学习测验以及stroop色词命名测验成绩出现下降的人数较多，分别占总人数的29．4％和23．5％，并且POCD组有50％以上的患者均出现了该两项测验成绩的下降。统计结果显示两组间在术中出入量以及麻醉后恢复室（postanesthesia care unit，PACU）停留时间、拔管时间、手术时间上的差异无统计学意义（P〉0．05），所有患者术前VAS评分均为0分，术后1、3d分别为（4±2）分，（2±1）分，经分析，组内比较差异有统计学意义（P〈0．05），而组间比较差异无统计学意义。结论青少年脊柱侧凸矫形术后7dPOCD发生率为29．4％，需要引起足够的重视。Objective To observe the incidence of postoperative cognitive dysfunction （POCD） in adolescent scoliosis patients. Methods Fifty-two patients with ASA grade I or II , aged from 11 to 18 years, undergoing elective posterior scoliosis orthopedic surgery were enrolled. Patients were assigned into POCD group or NONPOCD group according to their performances of neuropsychological tests. The tests were as follows： mini mental state examination （MMSE）, visual verbal learning test, stroop color word test, digit span test, trail making test and digit symbol test. Cognitive function was assessed respectively on one day before surgery and the seventh day after surgery. Age, gender, years of education, past medical history, visual analog scale （VAS） on the first and third day after surgery and postoperative complications were recorded. Then the data was statistically analysed. Results One patient was excluded because his preoperative MMSE score was 21, other Fifty-one patients finished the tests. According to the diagnostic criteria, fifteen patients developed POCD （29.4%）. After calculation, it is found that many patients showed decline in the performance of visual verbal learning test （29.4%） and stroop color naming test （23.5%）. In addition, more than fifty percent of the patients in POCD group also showed decline in these two tests. Statistical analysis showed that there was no significant difference between POCD and NONPOCD group on intraoperative fluid intake and loss, length of stay in postanesthesia care unit（PACU）, extubation time or duration of surgery （P〉0.05）. The VAS score of all patient at 1 d before surgery was 0; and at 1, 3 d after surgery, this score was （4±2） and （2±1）, respectively, which there exist statistically significant within-group difference （P〈0.05）, but no difference between the two groups. Conclusions The incidence of POCD is 29.4% on the seventh day after scoliosis orthopedic surgery, to which full attention must be paid.

关 键 词：脊柱侧凸矫形手术 术后认知功能障碍 临床研究 

分 类 号：R749.2[医药卫生—神经病学与精神病学]