长托宁对老年冠心病患者腹部手术后早期认知功能的影响  

Impact of Penehyclibine Hydrochloride on abdominal early postoperative cognitive function of elderly patients with coronary heart disease

作　　者：吴林纳 孟海兵[1] 丁国友[1] 

机构地区：[1]解放军第九四医院麻醉科,江西南昌330006

出　　处：《中国医药导报》2014年第35期15-19,24,共6页China Medical Herald

基　　金：江西省卫生厅科技计划项目(编号20132086)

摘　　要：目的：评价不同剂量长托宁对老年冠心病患者腹部手术后早期认知功能的影响及心肌保护作用。方法选择2012年3月-2014年2月解放军第九四医院收治的120例拟行腹部开腹手术老年冠心病患者，随机分为A、B、C组和对照组，各组30例，A、B、C组和对照组分别于术前40 min给予肌注长托宁0.005、0.01、0.02 mg/kg及东莨菪碱0.006 mg/kg，观察各组给药前（T1）、给药30 min（T2）、手术30 min（T3）、术毕5 min（T4）心率（HR）、血压、心率变异性，术前、术后24 h心肌肌钙蛋白（cTnI）水平，术前及术后24、48、72 h简易精神状况检查（MMSE）评分及术后认知功能障碍（POCD）发生率。结果 T1-4各组HR、收缩压（SBP）、舒张压（DBP）和低频功率/高频功率（LF/HF）比值均有显著变化（P〈0.05），其中A组T2、T3 HR显著高于T1，B、C组T2 HR显著高于T1（P〈0.05）；各组T3、T4 SBP均显著高于T1（P〈0.05）；各组T3 DBP均显著高于T1（P〈0.05）；各组T2、T3 LF/HF与T1比较差异均有统计学意义（P〈0.05）；T1、T4各组间HR、SBP、DBP和LF/HF比值比较差异均无统计学意义（P〉0.05），T2、T3各组间HR、SBP和LF/HF比值比较差异均有统计学意义（P〈0.05），其中A、B、C组HR、SBP、LF/HF均低于对照组（P〈0.05），A、B、C组组间比较差异均无统计学意义（P〉0.05）。各组术前、术后24 h外周血cTnI水平无显著变化，组间比较差异也无统计学意义（P〉0.05）。 A组术前至术后72 h MMSE评分无显著变化（P〉0.05），B、C组和对照组术前至术后72 h MMSE评分有显著变化（P〈0.05），B、C组和对照组术后24、48、72 h MMSE评分均显著低于术前（P〈0.05）；术后24、48、72 h各组间MMSE评分差异有统计学意义（P〈0.05），其中A组术后24、48 h MMSE评分均高于B组（P〈0.05），术后24、48、72 h MMSE评分均高于C组和对照组（P〈0.05），B组术后24、48 h MMSE�Objective To evaluate the functional impact and the cardioprotective effect of different doses of Penehycli-bine Hydrochloride on abdominal early postoperative cognitive function of elderly patients with coronary heart disease. Methods 120 cases of elderly coronary patients undergoing abdominal laparotomy from March 2012 to February 2014 in NO.94 Hospital of People＇s Liberation Army were randomly divided into group A, B, C and the control group, with 30 cases in each group. Group A, B, C and the control group were given intramuscular injection of Penehyclibine Hy-drochloride 0.005, 0.01, 0.02 mg/kg and Scopolamine 0.006 mg/kg 40 min respectively before surgery. The periopera-tive heart rate （HR）, blood pressure, heart rate variability before admin istration （T1）, administered 30 min （T2）, 30 min after operation （T3）, postoperative 5 min （T4）, the level of cardiac troponin （cTnⅠ） in preoperative and postoperative 24 h, the MMSE score in preoperative and postoperative 24, 48, 72 h, and the incidence of POCD in each group were ob-served. Results HR, SBP, DBP and LF/HF ratio in T1-4 of each group were significant changed （P〈 0.05）, of which, HR in T2, T3 of group A were significantly higher than those in T1, HR in T2 of group B, C were significantly higher than that in T1 （P〈 0.05）; SBP of each group in T3, T4 were significantly higher than that in T1 （P 〈 0.05）;DBP of each group in T3 were significantly higher thannbsp;that in T1 （P 〈0.05）; LF/HF of each group in T2, T3 were significantly different with T1 （P〈0.05）; HR, SBP, DBP and LF/HF ratio of each group in T1, T4 were not significantly different （P〉 0.05）, HR, SBP, and LF/HF ratio of each group in T2, T3 were significantly different （P〈0.05）, HR, SBP, LF/HF of group A, B, C were lower than those in the control group （P〈0.05）, the differences among the three groups were not statistically significant （P〉0.05）. Peripheral blood cTnⅠ levels of each group in preoperative and postoper

关 键 词：术后认知功能障碍 盐酸戊乙奎醚 心肌保护 冠心病 

分 类 号：R749[医药卫生—神经病学与精神病学]