通窍益脑方对老年患者术后认知功能的影响  

The effect of Tongqiao Yinao decoction on postoperative cognitive dysfunction in elderly patients

作　　者：陶红蕾[1] 姜云峰[1] 马婷婷[1] 李国政[1] 彭从斌[1] 

机构地区：[1]浙江省立同德医院麻醉科,浙江省杭州310012

出　　处：《中国基层医药》2014年第20期3051-3054,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：基金项目：浙江省中医药科技计划项目（20108542488）

摘　　要：目的：探讨“通窍益脑方”对老年患者术后认知功能障碍（ POCD）的治疗效果和作用机制。方法选择全身麻醉下行骨科手术患者100例，按随机数字表分为“通窍益脑方”治疗组和对照组，每组50例。对照组常规治疗，不口服中药。治疗组在常规治疗基础上，每天2次口服中药汤剂“通窍益脑方”150 mL，连续服用15 d。采用简易智能状态检查法分别于麻醉前1 d及术后第1、3、7天评估患者认知功能，另于相应时间同时采血样检测患者的IL-6水平。结果两组术前基本情况差异无统计学意义。术后1 d，治疗组和对照组POCD发生率分别为30％和38％；术后3 d，治疗组和对照组POCD发生率分别为28％和20％；术后7 d，治疗组和对照组POCD发生率分别为20％和12％，两组差异有统计学意义（χ2＝4．332，P＝0．037）。与术前比较，两组术后3 d血清中IL-6含量均显著增加，差异有统计学意义（对照组，t＝2．412，P＝0．009；治疗组，t＝1．429，P＝0．039）；对照组术后7 d仍高于术前水平（t＝0．851，P＝0．049）；但是治疗组术后7 d已基本恢复，与术前差异无统计学意义（P＝0．404）；与对照组比较，治疗组术后3 d IL-6含量显著降低（t＝1．198， P＝0．035）。血清IL-6含量变化与MMSE评分负相关（r＝-0．782，P＝0．022）。结论“通窍益脑方”可有效改善老年患者术后认知功能障碍的症状，推测其作用机制可能与抑制血清中的IL-6有关。Objective To investigate the effect of Tongqiao Yinao decoction （ TYD） on postoperative cogni-tive dysfunction in elderly patients and its underlying mechanisms .Methods 100 anesthetic patients for orthopedic surgery were randomly divided into the TYD-treated group and control group ,50 patients in each group .In TYD-trea-ted group,patients received 150mL TYD orally,twice daily for constitutive 15 days,beginning from the day of admis-sion in addition to conventional symptomatic and supportive treatment .While patients in control group received no TYD.Mini-mental state examination （ MMSE） was used to evaluate the patients′cognitive function before and after anesthesia.Meanwhile,blood samples of patients were also collected to test the expression levels of IL -6.Results There was no significant difference between the two groups before operation .However ,TYD-treated patients had signif-icantly lower incidence rate of POCD than the controls （ 20% in the control group , and 12% in the TYD-treated group;χ2 =4.332,P=0.037） 7 days after operation.The incidence rates of POCD in the TYD-treated group and control group were 30%and 38%1 day after operation （ P〉0.05）,28% and 20% 3 days after operation （ P〉0.05）,respectively.Compared with that before operation ,the blood levels of IL-6 in the two groups significantly increased 3 days after operation （control group,t=2.412,P=0.009;TYD-treated group,t=1.429,P=0.039）.In contrast to the control group,the level of IL-6 in TYD-treated group declined to the baseline （the control group,t=0.851,P=0.049;TYD-treated group,P=0.404）.Interestingly,compared with the controls,the TYD-treated patients had a significant lower level of IL-6 after operation （t=1.198,P=0.035）.Furthermore,Pearson correlation analysis showed that change of IL-6 level in blood was negatively correlated with MMSE score （r=-0.782,P=0.022）. Conclusion TYD can improve postoperative cognitive dysfunction in elderly patients ,presumably through decreasing the level of IL-6 in blo

关 键 词：术后认知功能障碍 通窍益脑方 白细胞介素-6 

分 类 号：R277.7[医药卫生—中医学]