長托寧對老年骨科全身麻醉患者術后認知功能障礙的影響

廖生根　李坤　張桂華

[摘要]目的 探討長托寧對老年骨科全身麻醉患者術后認知功能障礙的影響。方法 選擇我院2015年4月～2016年8月收治的144例擬行老年骨科全身麻醉患者，根據不同的治療方式分為A組、B組、C組，每組48例。A組在術前30 min肌內注射長托寧1.0 mg，B組肌內注射阿托品0.5 mg，C組患者不采用任何術前用藥。比較三組患者術前1 d和術后1、3 d的MMSE評分及POCD發生情況。結果 三組患者在術后1、3 d時的MMSE評分均低于本組術前1 d，差異有統計學意義（P<0.05）。A組術后1、3 d的MMSE評分均明顯低于B組、C組，差異有統計學意義（P<0.05）。A組術后的POCD發生率明顯低于B組、C組，差異有統計學意義（P<0.05）。結論 長托寧應用于老年骨科全身麻醉患者，易降低POCD發生率，并對患者術后認知功能產生相關影響，故應引起重視。

[關鍵詞]長托寧；老年人；全身麻醉手術；認知功能障礙；影響

[中圖分類號] R614.2 [文獻標識碼] A [文章編號] 1674-4721（2017）12（b）-0110-03

[Abstract]Objective To investigate the influence of Penehyclidine Hydrochloride on cognitive dysfunction in elderly patients after general anesthesia in department of orthopedics.Methods From April 2015 to August 2016，144 cases of elderly general anesthesia patients in department of orthopedics in our hospital were selected and divided into group A，group B，group C according to different treatment methods，each group had 48 cases.Group A received intramuscular injection of Penehyclidine Hydrochloride 1.0 mg at 30 min before operation，group B received intramuscular injection of Atropine 0.5 mg，group C were not treated with any prior medication.The MMSE score and the incidence rate of POCD at preoperative 1 day and postoperative 1 day，3 days were compared between the three groups.Results The MMSE scores of the three groups at preoperative 1 day were lower than that of at the postoperatively 1 day，3 days，and the difference was statistically significant （P<0.05）.The MMSE score of group A at postoperative 1 day，3 days were significantly lower than those in group B and group C，and the difference was statistically significant （P<0.05）.The incidence rate of POCD in group A was lower than that group B and group C，the difference was statistically significant （P<0.05）.Conclusion Penehyclidine Hydrochloride should be used for elderly patients with general anesthesia in department of orthopedics can reduce the incidence of patients with POCD，and which has a related influence on the postoperative cognitive function of the patients，it should be paid attention to.

[Key words]Penehyclidine hydrochloride；Elderly；General anesthesia；Cognitive dysfunction；Influence

老年人患者在手術后易出現認知功能障礙（postoperative cognitive dysfuction，POCD），尤其是骨科全身麻醉時會產生相應并發癥，嚴重影響患者的術后治療效果[1]。POCD屬于一種中樞神經并發癥，臨床表現為記憶力減弱、精神紊亂和情緒焦慮和急躁等[2-3]，嚴重者易喪失語言能力和基本生活能力，直致死亡，因此應積極地采取有效措施來避免術后出現POCD癥狀。有研究顯示，中樞特定區域的膽堿能通路參與老年患者POCD的發生[4]。長托寧屬于抗膽堿類新藥，在阻斷外周膽堿能受體的同時，影響中樞膽堿能受體功能[5]。本研究旨在探討長托寧對老年骨科全身麻醉患者POCD的影響，現報道如下。

1資料與方法endprint