人格维度与老年人胃肠外科术后认知功能障碍的关系

发布时间：2018-03-30 04:11

  本文选题：老年人　切入点：人格　出处：《河北医科大学》2014年硕士论文

【摘要】：目的:明确不同人格维度与老年人胃肠外科术后认知功能障碍（POCD）的关系，为预测老年人术后认知功能障碍提供参考，为预防老年人术后认知功能障碍提供可能的方法。 方法:依据纳入排除标准选择择期全麻下行腹部胃肠手术的老年患者65例，年龄65~70岁。所有患者均采用全身麻醉，且不使用术前药物。入室后监测心电图，心率，血氧饱和度，BIS，局麻下行桡动脉穿刺、中心静脉穿刺并监测有创动脉压。用静脉注射芬太尼4μg/kg、依托咪酯150~300μg/kg使BIS降至40~60、顺阿曲库铵0.2mg/kg进行麻醉诱导，3min后行气管插管并机械通气。呼吸参数设置为潮气量6~8ml/kg，调节呼吸频率使呼末二氧化碳维持在35~40mmHg。麻醉维持：静脉泵注瑞芬太尼4~8μg·kg-1·h-1，呼末七氟烷浓度2%~2.5%，维持BIS在40~60之间，间断给予顺阿曲库铵维持肌松。手术结束前30min静脉注射芬太尼1μg/kg，术毕停用麻醉药物。避免使用已知的可能会引起认知功能下降的药物包括，异氟烷，阿托品，咪达唑仑等。符合拔管标准后拔除气管导管，监测生命体征平稳送返外科监护病房。于术后4h及24h对患者进行视觉模拟评分（visual analogue scale，VAS），对VAS≥3分的患者给予曲马多50mg静脉注射，15分钟后再行评估及处理，直至患者VAS评分＜3分为止。术前一天对患者进行艾森克人格问卷（EPQ），记录患者不同人格维度得分，并由同一位心理医师在术前一天和术后第七天对患者进行神经心理测试，判断患者是否发生POCD。记录患者的一般资料及手术时间，麻醉时间，文化程度，合并症（包括糖尿病、高血压、冠心病、贫血），吸烟史，饮酒史，是否应用新辅助化疗，术后是否发生谵妄，对所有因素进行多因素Logistic回归分析，探讨人格维度与POCD的关系。 结果:65例患者中有57例完成试验，其中10例发生POCD，发生率为17．86%。两组患者年龄、性别构成比、麻醉时间、手术时间均无统计学差异.多因素Logistic回归分析显示：P等级、L等级、性别、文化程度、贫血分级、是否吸烟、是否饮酒、是否输血、是否应用新辅助化疗、是否发生谵妄等因素与POCD发生没有相关性，E、N等级是POCD的危险因素，E、N等级每增高一个级别POCD发生率分别增高4.76倍和8.17倍，其回归系数分别为0.681、0.716。Logistic回归方程为：Log（P）=-10.772+2.101N+1.561E。用该方程预测POCD，其阳性预测值（PositivePredictive Value，PPV）为100%，，阴性预测值（Negative Predictive Value，NPV）为92.3%，灵敏度（sensitivity）为60%，特异度（specificity）为100%， 结论:情绪稳定性差，性格外向的患者发生术后认知功能障碍的风险高。
[Abstract]:Objective: to determine the relationship between different personality dimensions and cognitive dysfunction (POCD) in elderly patients after gastrointestinal surgery, and to provide a reference for predicting postoperative cognitive dysfunction in the elderly and to provide a possible method for preventing postoperative cognitive dysfunction in the elderly. Methods: 65 elderly patients, aged 65 to 70 years, undergoing abdominal gastrointestinal surgery under general anesthesia were selected according to the exclusion criteria. All patients were treated with general anesthesia, and no drugs were used before operation. Electrocardiogram (ECG) and heart rate (HR) were monitored after entering the room. Blood oxygen saturation (BIS), radial artery puncture under local anesthesia, Central venipuncture was performed and invasive arterial pressure was monitored. Intravenous injection of fentanyl (4 渭 g / kg) and etomidate (150 渭 g/kg) reduced the BIS to 40,60,3 minutes after anesthesia induction with cisatracurium 0.2mg/kg, tracheal intubation and mechanical ventilation were performed. The respiratory parameters were set as tidal volume of 6ml / kg. Anesthesia maintenance: intravenous infusion of remifentanil 48 渭 g kg-1 h-1, final sevoflurane concentration 2 and 2.5%, maintenance of BIS between 40 and 60, 30min was intravenously injected with fentanyl 1 渭 g / kg before surgery, and the anesthetic was stopped after surgery. Avoiding the use of drugs known to cause cognitive impairment included isoflurane and atropine. Midazolam, etc. Tracheal catheter is removed after meeting the extubation standard, The visual analogue score and visual analogue scale were performed at 4 and 24 hours after operation. Patients with VAS 鈮

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