老年患者体质类型与早期术后认知功能障碍的研究

发布时间：2018-07-31 05:27

【摘要】：目的:对中医体质学说与老年患者POCD的相关性进行研究,从中医体质特征上寻找规律,可能对老年患者POCD的辨证治疗治则的指导有临床意义。针对老年患者体质类型与术后认知功能状况,探索影响认知功能的影响因素,为围术期的中西医结合干预提供参考。方法:采用横断面临床流行病学调查方法,收集我院60-90岁在气管内插管全麻下拟行下肢手术的患者。于术前一天完成中医体重表和蒙特利尔认知评估表(MoCA)首页的填写。术前记录患者的住院号、性别、年龄、体重、文化程度、血压、HR、既往病史、术前Hb与术前Hct,术后记录患者的麻醉药物用量、手术时间、麻醉时间、输液量、出血量、尿量、手术类型、术后Hb、术后Hct、Hb差值、Hct差值。术后第三天再次完成蒙特利尔认知评估表(MoCA)的填写。完成病人基本资料的填写并输入计算机建立数据库,采用SPSS17.0统计软件进行描述性分析和推断性分析(χ2检验、t检验、秩和检验以及Logistic回归分析)。结果:术后认知功能障碍属于轻度认知损害,本次研究的老年患者发生POCD的人数为21人(12.7%),术后认知功能较术前认知功能发生认知下降的患者有75人(45%)。166位老年患者的体质类型分布为平和质59例(35.5%)、瘀血质30例(18.1%)、阳虚质30例(18.1%)、气虚质18例(10.8%)以及其它质29例(17.5%)。发生认知下降的患者的主要体质类型为平和质28(37.3%)、瘀血质17(22.7%)、阳虚质10(13.3%)、气虚质10(13.3%)、其它质10(13.3%)。不同性别在年龄、体重上存在统计学差异,有统计学意义(P0.05)。文化程度与年龄对术前认知功能异常的发生存在统计学相关性,有统计学意义(P0.05)。文化程度与年龄对术后认知功能异常的发生亦存在统计学相关性,有统计学意义(P0.05)。年龄、文化程度成为影响POCD发生的独立危险因素。手术类型与认知下降的发生存在统计学相关性,有统计学意义(P0.05)。经χ2检验,结果显示术前认知功能的评估结果与术后认知功能的评估结果之间具有统计学意义(P0.001),麦克尼玛尔检验显示两者有统计学意义(P0.05),证明术前与术后这两次认知评估结果存在一致性,Kappa=0.667,说明术前认知能的评估结果与术后认知功能的评估结果具有良好的一致性。瘀血质与文化程度存在统计学相关性,有统计学意义(P0.05)。阳虚质患者的体重与非阳虚质患者的体重的差异有统计学意义(P0.05)。结论:本研究中的老年患者的体质类型主要为平和质、瘀血质、阳虚质。发生认知下降的老年患者的主要体质类型为平和质、瘀血质、阳虚质以及气虚质。本研究的老年人的体质以平和质为主。术前认知能的评估结果与术后认知功能的评估结果具有良好的一致性。年龄与文化程度为影响POCD发生的独立危险因素。手术类型亦是影响认知下降发生的独立影响因素。本研究样本量较少,且未行多中心研究。今后可施行大样本的多中心研究,为中医体质与老年人早期术后认知功能障碍的研究提供更充足的依据及更可靠的研究结果。
[Abstract]:Objective: To study the relationship between the Physique Theory of traditional Chinese medicine and the POCD of the elderly patients and to find the law from the physique of traditional Chinese medicine. It may be of clinical significance to the guidance of the treatment and treatment of POCD in the elderly patients. Medical combined intervention provided reference. Methods: the patients who were 60-90 years old under the tracheal intubation general anesthesia were collected by the method of cross-sectional epidemiological investigation. The patients were completed on the front page of the Chinese medicine body weight list and the Montreal cognitive assessment table (MoCA) one day before the operation. The hospital number, sex, age, weight, and weight were recorded before the operation. Degree, blood pressure, HR, past medical history, preoperative Hb and preoperative Hct, record the dosage of narcotic drugs, operation time, anesthesia time, infusion volume, bleeding volume, urine volume, operation type, postoperative Hb, postoperative Hct, Hb difference, Hct difference. Complete the completion of the Montreal cognitive assessment form (MoCA) again third days after the operation. Complete the basic information of the patients. Descriptive analysis and inferential analysis (x 2 test, t test, rank sum test and Logistic regression analysis) were used in SPSS17.0 statistical software for descriptive analysis and inference. Results: postoperative cognitive impairment was mild cognitive impairment, and the number of POCD in the elderly patients in this study was 21 (12.7%), and postoperative cognitive function was found. There were 75 (45%) patients with cognitive decline of cognitive function before operation (45%).166, 59 cases (35.5%), 30 cases (18.1%), 30 cases of Yang deficiency (18.1%), 18 (10.8%) and 29 (17.5%). The main physical types of cognitive decline were flat and qualitative 28 (37.3%), blood stasis. 7 (22.7%), Yang deficiency substance 10 (13.3%), Qi deficiency 10 (13.3%), other mass 10 (13.3%). There was statistical difference between age and body weight of different sex (P0.05). The degree of culture and age were statistically related to the occurrence of cognitive dysfunction before operation (P0.05). Cultural degree and age were different in cognitive function after operation. There was statistical correlation and statistical significance (P0.05). Age and educational level were independent risk factors affecting the occurrence of POCD. There was a statistically significant correlation between the type of operation and the occurrence of cognitive decline (P0.05). The results of the preoperative cognitive function evaluation and postoperative cognitive function were revealed by the chi square test. The results of the evaluation were statistically significant (P0.001). The McNemar test showed that the two were statistically significant (P0.05), demonstrating the consistency between the two cognitive assessment results before and after the operation, and Kappa=0.667. The results showed that the evaluation results of cognitive ability before operation were in good agreement with the results of postoperative cognitive ability assessment. There was statistical significance (P0.05). The body weight of patients with Yang deficiency and non Yang deficiency was statistically significant (P0.05). Conclusion: the physical types of the elderly patients in this study were mainly flat, blood stasis and yang deficiency. The main physical types of elderly patients with cognitive decline were flat and flat. Quality, ecchymosis, Yang deficiency and Qi deficiency. The physique of the elderly in this study was mainly flat and qualitative. The assessment results of pre operation cognitive ability were in good agreement with the evaluation results of postoperative cognitive function. Age and educational level were independent risk factors affecting the occurrence of POCD. The surgical type also influenced the independent influence of cognitive decline. In the future, a multi center study of large samples can be carried out to provide more sufficient basis and more reliable research results for the study of Chinese Medical Constitution and the early postoperative cognitive impairment of the elderly.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R619

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