参附注射液对老年骨科手术患者全麻术后认知功能影响的临床研究

目的 探讨参附注射液对老年骨科手术患者全麻术后认知功能的影响.方法 选择100例骨科择期手术患者,按美国麻醉医师协会体格分级属Ⅱ～Ⅲ级,年龄60 ～ 89岁,随机分为参附注射液组(治疗组)和对照组,每组各50例.手术切皮后,治疗组静脉输注参附注射液50 mL加生理盐水150 mL,对照组于同时间输注生理盐水200 mL.比较两组患者入室,气管插管后,麻醉后30、60 min,拔管后5、30 min的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2).比较两组患者手术时间、术中低血压时间、出血量、术后意识恢复时间,术前及术后3、7天肝肾功能及空腹血糖.分别于术前及术后第3、7天对患者进行认知功能测试.并对两组患者术后认知功能障碍(post-operative cognitive dysfunction,POCD)发生率进行比较.结果 两组患者麻醉中各时点MAP、HR、SpO2差异无统计学意义(P＞0.05).患者术前认知功能评分,手术时间,术中低血压时间,出血量,术前及术后3、7天肝肾功能以及空腹血糖差异无统计学意义(P＞0.05).治疗组术后意识恢复时间明显短于对照组,差异有统计学意义(P＜0.05).术后3、7天治疗组认知功能评分明显优于对照组,差异有统计学意义(P＜0.05),治疗组POCD发生率[3天:12％(6例)；7天:8％(4例)]明显低于对照组[3天:20％(10例)；7天:14％(7例)],差异有统计学意义(P＜0.05).结论 参附注射液可提高老年骨科手术患者全麻术后认知功能,降低术后认知功能障碍的发生率,缩短术后意识恢复时间.

Clinical Study of Shenfu Injection on the Post-operative Cognitive Dysfunction in Senile Patients Receiving the Orthopedic Surgeries after General Anesthesia

Objective To study the effect of Shenfu Injection（SI） on the post-operative cognitive dysfunction in senile patients receiving the orthopedic surgeries after general anesthesia. Methods 100 patients,60-89 years old,waiting for selective surgery at the orthopedics department,were randomly assigned to two groups,the SI group（50 cases） and the control group（50 cases） ,who met the standard of the American Society of Anesthesiologists（ASA） Ⅱ-Ⅲ. After surgical incision,patients in the SI group were transfused with SI 200 mL（50 mL SI was added in 200 mL normal saline） ,while those in the control group were transfused with 200 mL normal saline at the same time. The mean arterial pressure（MAP） ,heart rate（HR） ,and oxygen saturation（SpO2） were compared between the two groups before anesthesia,after intubation,30 min and 60 min after anesthesia,5 min and 30 min after extubation. The time for surgery,the time of intra-operative hypotension,the volume of hemorrhage,the time for post-operative consciousness recovery,the liver function,the kidney function,and the fasting blood glucose of patients before surgery,3 days and 7 days after operation were compared. The cognitive functions of patients were tested before surgery,3 days and 7 days after operation. The incidence of post-operative cognitive dysfunction of patients was compared between the two groups. Results There was insignificant difference in MAP,HR,and SpO2 between the two groups at each time point（P0.05） . There was insignificant difference in the pre-operative cognitive function score,the time for surgery,the time of intra-operative hypotension,the volume of hemorrhage,the liver function,the kidney function,and the fasting blood glucose between the two groups（P0.05） . The time for post-operative consciousness recovery was obviously shorter in the SI group than in the control group,showing significant difference（P0.05） . The post-operative 3-day and 7-day cognitive function scores were obviously better in the SI group than in the control group,showing significant difference（P0.05） . The incidence of post-operative cognitive dysfunction of the SI group [3 days：12%（6 cases）;7 days：8%（4 cases） ] was significantly lower than that of the control group [3 days：20%（10 cases）;7 days：14%（7 cases） ]（P0.05） . Conclusion SI could improve the post-operative cognitive function of senile patients receiving the orthopedic surgeries after general anesthesia,lower the incidence of post-operative cognitive dysfunction rate,and shorten the time for post-operative consciousness recovery.