氢气吸入对骨科老年患者术后认知功能障碍的影响

发布时间：2018-04-30 17:04

  本文选题：氢气吸入 + 老年骨科患者　； 参考：《天津医科大学》2017年硕士论文

【摘要】：背景:术后认知功能障碍(postoperative cognitive dysfunction,POCD)是麻醉和手术后出现的注意力不能集中、记忆能力下降等认知功能改变,严重的患者还会出现人格和社会行为的能力下降,其临床表现为认知能力减退、焦虑、记忆缺损、语言理解能力和社会融合能力减退[1]。POCD不仅延长患者住院时间,增加住院费用,而且增加患者术后病死率,引发了一系列医学、社会及经济问题。POCD的病因及发病机制至今尚不明确,但越来越多的研究提示炎症反应可能在其中发挥了相当重要作用[2,3]。氢气是一种新型的气体信号分子,具有多种作用,如:抗炎、抗氧化、抗凋亡、信号调节,并对多种神经系统疾病具有保护性作用[4,5]。本研究拟观察氢气吸入是否减少老年骨科患者POCD的发生及其可能机制,并为其预防和治疗POCD提供理论依据。目的:探讨氢气吸入对骨科老年患者术后认知功能障碍(POCD)的影响及其可能的机制。方法:拟在椎管内麻醉下择期行骨科手术患者54例,ASA分级Ⅱ或Ⅲ级,年龄≥75岁,采用随机数字表法,将患者分为2组:对照组(C组)和氢气吸入组(H组)。H组在麻醉前和手术结束后即刻分别给予含66.6%氢气和33.3%氧气的混合气体吸入60min,C组给予33.3%氧气吸入。于氢气吸入前(H1)、吸入30min(H2)、吸入60min(H3)测定动脉血气。采用简易智能状态检查表(MMSE)评估术前无认知功能障碍,并记录术前一天(M1)、术后第一天(M2)、术后第三天(M3)、术后第七天(M4)的认知功能评分,MMSE评分24分判定为POCD,记录术后不同时间点POCD的发生率。于气体吸入前(T1)、术后即刻(T2)、术后3h(T3)、术后6h(T4)采集动脉血样,测定白介素-6(IL-6)和超氧化物歧化酶(SOD)水平。结果:两组患者的一般情况各指标、手术时间和出血量的比较无统计学差异(P0.05)。高浓度氢气吸入不会影响患者的氧合功能,两组比较无统计学意义(P0.05)。H组患者在M2、M3和M4时间点的POCD发生率分别为23.3%、10%和3.3%,均小于C组(33.3%,16.7%和8.3%),但两组比较无统计学差异(P0.05)。与T1比较,T3、T4时两组患者IL-6明显升高,SOD活性明显降低(P0.05);与C组比较,T2-T4时H组患者IL-6水平明显减低,SOD活性明显增高(P0.05)。结论:氢气吸入可减少骨科老年患者术后认知功能障碍的发生率,其机制可能与调控炎症反应和氧化应激有关。
[Abstract]:Background: postoperative cognitive dysfunctional POCD is a kind of cognitive dysfunction after anaesthesia and surgery, such as the loss of attention, the decrease of memory, and the decrease of personality and social behavior in severe patients. The clinical manifestations of POCD were cognitive impairment, anxiety, memory impairment, language comprehension and social integration. POCD not only prolonged the hospitalization time and increased the cost of hospitalization, but also increased the postoperative mortality of patients, which led to a series of medicine. The etiology and pathogenesis of social and economic problems, POCD, are still unclear, but more and more studies suggest that inflammation may play a very important role in it. Hydrogen is a new type of gas signaling molecule, which has many functions, such as anti-inflammation, anti-oxidation, anti-apoptosis, signal regulation, and has protective effect on many nervous system diseases. The purpose of this study was to investigate whether hydrogen inhalation could reduce the incidence and possible mechanism of POCD in elderly orthopaedic patients, and to provide theoretical basis for the prevention and treatment of POCD. Objective: to investigate the effect of hydrogen inhalation on cognitive dysfunction (POCD) in elderly orthopaedic patients and its possible mechanism. Methods: 54 patients with ASA grade 鈪，

本文编号：1825405