围术期保温对老年胸科手术患者POCD的影响  

Effects of perioperative thermal insulation on postoperative cognitive dysfunction in elderly patients undergoing thoracic surgery

作　　者：马琨[1] 黄玉哲[2] 米梅艳[1] 马朋羽[3] MA Kun;HUANG Yuzhe;MI Meiyan(Department of Anesthesiology,The Fourth Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China;不详)

机构地区：[1]河北省石家庄市第四医院麻醉科,050011 [2]河北医科大学人体解剖学教研室 [3]河北省石家庄市第一医院麻醉科,050011

出　　处：《河北医药》2020年第6期845-848,共4页Hebei Medical Journal

基　　金：石家庄市科学技术研究与发展指导计划(编号:171462333)。

摘　　要：目的评价围术期保温对老年胸科手术患者术后认知功能障碍(POCO)及术后并发症的影响。方法收集2016年1月至2018年10月收治的80例老年胸科癌症患者的临床资料,患者随机分为围术期常规处理40例(常规组),围术期常规结合保温处理组40例(试验组)。2组患者麻醉诱导相同,维持采用瑞芬太尼0.1~0.3μg·kg-1·min-1和丙泊酚术中持续泵注。比较2组麻醉前(T1)、单肺通气(one-lung ventilation,OLV)开始(T2)、OLV 1 h(T3)、手术结束即刻(T4)的体温(temperature,Temp)、心率(heart rate,HR)与平均动脉压(mean arterial pressure,MAP),比较2组患者术前及术后3 d简易智力状态检查量表(Simple mental state examination scale,MMSE)、术后恢复质量评估量表(Post-operative quality recovery scale,PQRS)、蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评分等,并分析2组术后并发症情况。结果Temp、HR及MAP在时间、组间及交互方面均有明显差异(P<0.05),试验组4个时间点两两比较差异均无统计学意义(P>0.05),常规组4个时间点两两比较比较均有显著差异(P<0.05)。T2、T3和T4时间点试验组的Temp均显著高于常规组(P<0.05),而HR与MAP均显著低于常规组(P<0.05);术前2组患者的MMSE、MoCA、PQRS评分差异均无统计学意义(P>0.05),术后3 d时,试验组MMSE、PQRS、MoCA评分均明显高于常规组(P<0.05)。术后3 d 2组间的POCD、术后谵妄发生率差异无统计学意义(P>0.05),而试验组的术后低体温及寒战发生率均显著低于常规组(均P<0.05)。结论围术期保温有利于维持老年胸科手术患者的生命体征稳定,并可有效地降低术后认知功能损伤。Objective To investigate the effect of perioperative thermal insulation on the postoperative cognitive dysfunction(POCD)and postoperative complications in elderly patients undergoing thoracic surgery.Methods The clinical data about 80 elderly patients with thoracic cancer who were admitted and treated in our hospital from January 2016 to October 2018 were collected,and the patients were randomly divided into perioperative period routine treatment group(control group,n=40)and perioperative period routine treatment combined with thermal insulation treatment group(experimental group,n=40).The anesthesia induction was performed in both groups,with 0.1~0.3μg·kg-1·min-1 and continuously intraoperative pumping of propofol.The temperature(Temp),heart rate(HR)and mean arterial pressure(MAP)before anesthesia(T1),at the beginning of single lung ventilation(OLV),at 1h after OLV,surgical end time(T4)were observed and compared between the two groups.Moreover,the simple mental state examination(MMSE),postoperative recovery quality assessment scale(PQRS)and montreal cognitive assessment(MoCA)before operationg and after operation were observed and compared between the two groups.Results There were significant differences in Temp,HR and MAP at different time points between the two groups(P<0.05).There were no significant differences in the indexes mentioned above in experimental group in the four time points between any two time points each other(P>0.05),however,there were significant differences in control group(P<0.05).The Temp levels at T2,T3 and T4 in experimental group were significantly higher than those in control group(P<0.05),but the HR and MAP at T2,T3 and T4 in experimental group were significantly lower than those in control group(P<0.05).Before operation there were no significant differences in MMSE,MoCA and PQRS scores between the two groups(P>0.05).And the MMSE,PQRS and MoCA scores at 3 days after operation in experimental group were significantly higher than those in control group(P<0.05).There was no significan

关 键 词：围术期保温 胸科手术 术后认知功能障碍 麻醉 

分 类 号：R971.2[医药卫生—药品]