加味参附汤合黄连阿胶汤对骨科手术后谵妄患者认知功能的影响  

Effect of Modified Shenfutang Combined with Huanglian Ejiao Tang on Postoperative Cognitive Dysfunction of Patients with Postoperative Delirium after Orthopedics Operation

作　　者：占紫龙 程志刚[2] 艾江平 王佳斌 ZHAN Zi-long;CHENG Zhi-gang;AI Jiang-ping;WANG Jia-bin(Sanya People＇s Hospital, Sanya 572000, China;Second Hospital Affiliated to Guiyang College of Traditional Chinese Medicine, Guiyang 550001, China)

机构地区：[1]三亚市人民医院,海南三亚572000 [2]贵阳中医学院第二附属医院,贵阳550001

出　　处：《中国实验方剂学杂志》2018年第12期188-193,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：海南省自然科学基金面上项目(830865)

摘　　要：目的：探讨加味参附汤合黄连阿胶汤治疗骨科手术后谵妄（POD）患者认识功能障碍（POCD）的改善,及对血清神经元特异性烯醇化酶（NSE）,S-100β蛋白、炎症反应和氧化应激损伤的影响。方法：采用区组随机法,将104例患者按以1∶1比例分为对照组和观察组各52例。对照组口服氟哌啶醇片,4～20 mg·d^-1,分3次服用。观察组在对照组治疗的基础上给予加味参附汤合黄连阿胶汤内服,1剂/d。两组疗程均连续治疗10 d。评价两组简易精神状态评价量表（MMSE）,谵妄量表（DRS）,谵妄消失时间、谵妄分级量表（DRS-R-98）;检测治疗后NSE,S-100β蛋白,白细胞介素-6（IL-6）,肿瘤坏死因子-α（TNF-α）,超氧化物歧化酶（SOD）,丙二醛（MDA）等水平;采用临床疗效总评量表（CGI-GI）评价临床疗效。结果：观察组显效率为88.64%,高于对照组的69.23%,差异有统计学意义（χ^2=5.765,P〈0.05）;在治疗后第5天和第10天,观察组CAM和DRS-R-98评分均低于对照组,MMSE高于对照组（P〈0.05,P〈0.01）。观察组在治疗后CAM和DRS-R-98评分下降幅度多于对照组,MMSE升高幅度多于对照组（P〈0.01）;治疗后观察组患者ADL和中医证候评分均低于对照组（P〈0.01）;观察组平均谵妄消失时间短于对照组（P〈0.01）;观察组患者NSE,S-100β,IL-6,TNF-α和MDA水平均低于对照组,SOD水平高于对照组（P〈0.01）。结论：在西医治疗的基础上服用加味参附汤合黄连阿胶汤治疗POD,可加快POD的康复,改善认知功能,减轻症状,提高术后患者的日常生活能力,并能具有减轻氧化应激和炎症反应损伤,保护脑神经细胞效应,值得临床使用。Objective： To discuss the efficacy of Shenfutang combined with Huanglian Ejiao Tang in improving the postoperative cognitive dysfunction（ POCD） of patients with postoperative delirium（ POD） after orthopedics operation,and its effect on levels of neuron specific enolase（ NSE）,S-100β protein,inflammatory response and oxidative stress injury. Method： One hundred and four patients were randomly divided into control（ 52 cases） group and observation group（ 52 cases） according to the ratio of 1 to 1. Patients in control group got haloperidol tablets,4-20 mg/days,3 take. In addition to the therapy for control groups,patients in observation group were also given modified Shenfutang combined with Huanglian Ejiao Tang,1 dose/day,for 10 successive days. And the mini-mental state examination（ MMSE）,delirium rating scale（ DRS）,disappearance time of postoperative delirium and delirium rating scale（ DRS-R-98） were evaluated. Before and after treatment,levels of NSE,S-100β,interleukin-6（ IL-6）,tumor necrosis factor-α（ TNF-α）,superoxide dismutase（ SOD） and malondialdehyde（ MDA） were detected. The clinical efficacy was evaluated by the scale of clinical global impression（ CGI-GI）. Result： The total effective rate in observation group was 88. 64%,which was higher than69. 23% in control group（ χ^2= 5. 765,P〈0. 05）. And at the 5 thand 10 thday after the treatment,scores of CAM and DRS-R-98 in observation group were lower than those in control group,and MMSE was higher than that in control group（ P〈0. 05,P〈0. 01）. CAM and DRS-R-98 in observation group reduced more significantly than those in control group,but MMSE increased more significantly than that in control group（ P〈0. 01）. Scores of ADL and traditional Chinese medicine（ TCM） syndrome in observation group were both lower than those in control group（ P〈0. 01）. The average disappearance time of postoperative cognitive dysfunction in observation group was shorter than that in control group�

关 键 词：骨科 术后谵妄 认识功能障碍 参附汤 黄连阿胶汤 神经元特异性烯醇化酶 S-100Β蛋白 炎症因子 

分 类 号：R274[医药卫生—中医骨伤科学] R274.9[医药卫生—中医学]