老年人髋关节置换术后认知功能障碍的研究(1)
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【摘要】 目的 探明咪达唑仑对于髋关节置换手术老年患者术后认知功能(POCD)的影响。方法 择期髋关节置换手术患者30例，年龄65~89岁，随机分成2组(n=30)：对照组和咪达唑仑组。对照组术中不用镇静镇痛药，咪达唑仑组术中给予咪达唑仑2~4 mg。两组于术前1 d、术后1 d、3 d记录简易智能状态检查法(MMSE)评估患者认知功能。结果 与术前比较，咪达唑仑组术后第1天MMSE评分降低(P<0.05)，而对照组术后第1天、第3天与术前比较MMSE评分比较差异无统计学意义(P>0.05)；2组间MMSE评分比较差异无统计学意义(P>0.05)。结论 咪达唑仑对于老年患者术后早期POCD有一定影响。
Study on postoperative cognitive dyfunction in elderly patients undergoing hip joint replacement
FU ChunMei, YANG Shaohui, HUANG Mingli, et al. Department of Anesthesiology, Chaonan Minsheng Hospital,Shantou 515144,China
【Abstract】 Objective To investigate the effect of midazolam on cognitive function undergoing hip joint replacement in the elderly. Methods Thirty ASAⅠor Ⅱ patients aged 65~89 years undergoing hip joint replacement were randomly divided into 2 groups(n=15 each): control group and midazolam group.In midazolam group 2~4 mg midazolam was injected into vein during operative. In control group the sedatives or the narcotics were not used. The Minimental state examination(MMSE) was useded to assess congnitive funtion 1 d before surgery and 1 d and 3 d after surgery. Results The MMES scores in 1 d after operation was significantly lower than in 1 d before operation in midazolam group. The MMES scores in 1 d and 3 d after operation were not significantly different from the MMES scores in 1 d before operation in control group.There were no significant difference the MMES scores between the 2 groups.Conclusion The midazolam has some influence on early postoperative cognitive function in elderly patients undergoing hip joint replacement.
术后认知功能障碍(POCD)是老年患者常见的术后神经系统并发症，可能与年龄、药物、麻醉方法、手术因素及基础疾病等因素有关[1]。苯二氮卓类是麻醉中广泛使用的镇静药物，目前对认知功能的影响仍存在争议，本研究主要探明苯二氮卓类药物咪达唑仑对于老年人POCD的影响。
1 资料与方法
1.1 一般资料 择期髋关节置换手术患者30例，年龄65~89岁，ASAⅡ级，心功能Ⅰ或Ⅱ级，随机分成2组(n=30)：对照组和咪达唑仑组。心肺功能未见异常；术前无明确的神经和精神系统疾病病史或未服用相应药物；手术时间不超过3 h；无严重的视觉或听力障碍；MMSE基础评分不低于20分，可配合完成认知功能测试。
1.2 麻醉方法
所有患者未用术前药。入室后常规监测心电图(ECG)、心率(HR)、血压(BP)和脉搏血氧饱和度(SpO2)。麻醉均采用脊椎硬膜外联合麻醉，选择L2,3间隙向上穿刺置管，术中蛛网膜下腔注射0.75%布比卡因0.8~1.5 ml及硬膜外追加0.5%布比卡因3~8 ml；常规面罩吸氧，对照组术中不用镇静镇痛药，咪达唑仑组术中给予咪达唑仑2~4 mg。术中维持收缩压的波动幅度不超过基础值25%，SpO2不低于96%；手术结束前给予吗啡1~1.5 mg硬膜外镇痛。
1.3 观察指标
采用简易智能状态检查法(MMSE)评估患者认知功能 ......
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