头针对老年髋关节置换术患者血清NSE、S-100β蛋白浓度及术后认知功能的影响

发布时间：2018-01-26 16:28

本文关键词： 头针老年患者髋关节置换术认知障碍神经元特异性烯醇化酶 S-β蛋白　出处：《中国中西医结合杂志》2016年06期 　论文类型：期刊论文

【摘要】：目的探讨头针对老年髋关节置换术患者血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、S-100β蛋白浓度与术后谵妄(postoperative delirium,POD)、术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率的影响。方法将84例择期腰麻与硬膜外联合阻滞麻醉下行髋关节置换术的老年患者按随机数字表法分为对照组、治疗组,每组42例。治疗组根据国际头针穴名标准化方案,取MS1额中线(从神庭向前1寸,包括神庭穴)、MS5顶中线(百会至前顶,包括百会及前顶穴),于术中行头针治疗。观察两组手术时间及术后住院时间,术中咪达唑仑用量、出血量、输液量、尿量、麻黄碱及阿托品使用率,POD发生率与术后3天(T_1)、1周(T_2)、3个月(T_3)及6个月(T_4)患者POCD发生率;两组各随机选择18例患者于麻醉前(t0)、术毕(t1)、术后6 h(t_2)、24 h(t_3)及48 h(t_4)颈内静脉采血,检测血清NSE、S-100β蛋白浓度。结果两组手术时间、术中咪达唑仑用量、出血量、输液量、尿量、麻黄碱及阿托品使用率比较,差异无统计学意义(P0.05)。与对照组比较,治疗组术后住院时缩短(P0.05),治疗组POD及术后各时间点POCD发生率降低(P0.05),治疗组t_2~t_4NSE蛋白表达降低(P0.05),t1~t4S-100β蛋白表达降低(P0.05),其他时间点两组比较差异无统计学意义(P0.05)。结论头针可减轻老年患者中枢神经系统损伤,改善术后认知功能。
[Abstract]:Objective to investigate the serum neuron specific enolase (specific) in elderly patients undergoing hip arthroplasty. S-100 尾 protein concentration and postoperative delirium delirium (POD). Postoperative cognitive dysfunction. Methods Eighty-four elderly patients undergoing hip arthroplasty under combined spinal and epidural anesthesia were randomly divided into control group and treatment group. 42 cases in each group. According to the international standard scheme of scalp acupuncture point name, the treatment group took the midline of MS1 forehead (1 inch forward from Shenting, including the midline of MS5 at Shenting point) (Baihui to anterior top, including Baihui and Qianding points). The operation time and postoperative hospitalization time, midazolam dosage, blood loss, transfusion volume, urine volume, ephedrine and atropine usage were observed. The incidence of POD and the incidence of POCD in patients with T _ (2), T _ (3) and T _ (4) at 3 days after operation were significantly higher than those in patients with T _ (2) and T _ (T _ (4)) at 3 days after operation. 18 patients in each group were randomly selected to collect blood from internal jugular vein before anesthesia, after operation, after operation, 6 hours after operation, 24 hours after operation, 24 hours after operation, 24 hours after operation, and 48 hours after operation. Results the operation time, intraoperative midazolam dosage, blood loss, transfusion volume, urine volume, ephedrine and atropine utilization rate were compared between the two groups. The difference was not statistically significant (P 0.05). Compared with the control group, the treatment group shortened the hospitalization time after operation (P 0.05). In the treatment group, the incidence of POD and POCD at different time points after operation was decreased (P 0.05), and the expression of t 2 and t 4 NSE protein in the treatment group was decreased (P 0.05). The expression of t4S-100 尾 protein decreased in the two groups, but there was no significant difference between the two groups at other time points. Conclusion scalp acupuncture can alleviate the injury of central nervous system in elderly patients. To improve postoperative cognitive function.
【作者单位】：青岛市海慈医疗集团麻醉科;青岛市海慈医疗集团药剂科;青岛市海慈医疗集团神经内科;青岛市市立医院麻醉科;
【基金】：青岛市市南区科技局资助项目(No.2014-14-032-yy)
【分类号】：R614
【正文快照】： 老年患者术后谵妄(postoperative delirium,POD)及认知功能障碍(postoperative cognitive dysfunction,POCD)发生率较高。部分POCD患者可发展为永久性POCD或痴呆,严重影响患者的生活质量并增加远期并发症的发生率和病死率,造成沉重的家庭及社会负担。研究显示头针对血管性及脑

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