硝酸甘油控制性降压对异氟醚麻醉下鼻内镜术后老年病人认知功能的影响

Objective To evaluate the effect of nitroglycerin (NTG)-induced hypotension on cognitive function after endoscopic sinus surgery performed under isoflurane anesthesia in elderly patients.Methods Forty ASAⅠ or Ⅱ patients aged 65-85 yr weighing 40-75 ks undergoing endoscopic nasal sinus surgery for chronic sinusitis under isoflurane anesthesia were randomly divided into 2 groups(n=20 each):control group(group C) and controlled hypotension group(group H).Anesthesia was maintained with isoflurane inhalation in both groups.In group H controlled hypotension was induced and maintained with continuous iv infusion of NTG at function was assessed 1 day before(baseline)and at 6,12,24 and 72h after surgery using Minimental State examination (MMSE) and scored.Results The MMSE scores were significantly decreased after surgery from 6h to 24h in both groups and were significantly lower in group H than in group C.There was no significant difference in MMSE scores between the 2 groups at 72h after surgery.The incidence of cognitive deficit was significantly higher in group H(55%) than in group C(25%).Conclusion Controlled hypotension induced by NTG may aggravate transient cognitive deficit after isoflurane anesthesia in elderly patients.     

硝酸甘油控制性降压对异氟醚麻醉下鼻内镜术后老年病人认知功能的影响

Objective To evaluate the effect of nitroglycerin (NTG)-induced hypotension on cognitive function after endoscopic sinus surgery performed under isoflurane anesthesia in elderly patients.Methods Forty ASAⅠ or Ⅱ patients aged 65-85 yr weighing 40-75 ks undergoing endoscopic nasal sinus surgery for chronic sinusitis under isoflurane anesthesia were randomly divided into 2 groups(n=20 each):control group(group C) and controlled hypotension group(group H).Anesthesia was maintained with isoflurane inhalation in both groups.In group H controlled hypotension was induced and maintained with continuous iv infusion of NTG at function was assessed 1 day before(baseline)and at 6,12,24 and 72h after surgery using Minimental State examination (MMSE) and scored.Results The MMSE scores were significantly decreased after surgery from 6h to 24h in both groups and were significantly lower in group H than in group C.There was no significant difference in MMSE scores between the 2 groups at 72h after surgery.The incidence of cognitive deficit was significantly higher in group H(55%) than in group C(25%).Conclusion Controlled hypotension induced by NTG may aggravate transient cognitive deficit after isoflurane anesthesia in elderly patients.     

The strength and function of hip abductors following anterolateral minimally invasive total hip arthroplasty

Objective： To analyze the extent of postoperative hip abductor insufficiency in primary total hip arthroplasty （THA） patients undergoing anterolateral minimally invasive （ALM1） approach, and to investigate whether the clinical outcomes are more favorable in femoral neck fracture （FNF） patients than in non-femoral neck fracture （nFNF） patients. Methods： A total of 48 patients were enrolled in this study. Each patient underwent a clinical examination preoperatively and 6, 12, 24 and 48 weeks postoperatively. The abductor torque, Trendelenburg＇s sign, gait velocity, Harris hip score, Oxford hip score, Westren Ontario and McMaster Universities （WOMAC） score and visual analog scale pain score were recorded. Statistical evaluation was performed with SPSS software version 18.0. The significance level was set at P〈0.05. Results： The abductor torque of the operated hip and the recovery ratio showed a gradual improving tendency from 6 weeks postoperatively until the last follow-up. Gait velocity, Harris hip score, Oxford hip score and WOMAC score improved significantly after the operation until 24 weeks postoperatively. In the FNF group, the abductor torque of the operated side and the recovery ratio were significantly higher than in nFNF group at 6 weeks postoperatively, however, as time passed, this trend tended to disappear. Conclusion： This study demonstrates that patients can obtain good abductor strength and function in the early postoperative period and the hip abductor function of patients who suffer from hip osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head could be significantly improved following ALMI THA.     

S-100B and neuron specific enolase in outcome prediction of severe head injury

Objective: To elucidate the role of S-100B and neuron specific enolase (NSE) in predicting the outcomes of patients with severe head injury. Methods：Forty patients with severe head injury were included in this study. The serum concentrations of S-100B and NSE were measured within 12 hours after head injury to investigate the correlation between serum levels of S-100B and NSE and outcome. Validity of both S-100B and NSE in outcome prediction was assessed with Receiver Operator Characteristic (ROC) curve. Results: The serum concentrations of S-100B and NSE of both groups, with favorable or unfavorable outcomes, were significantly higher than those of the normal group. The serum concentrations within 12 hours after head injury were closely correlated with the prognosis. Furthermore, according to the ROC curves of S-100B and NSE, S-100B was found better in predicting outcomes than NSE. Conclusions： S-100B and NSE may play importantroles in outcome prediction after severe head injury. Moreover, S-100B is clearly superior to NSE in terms of predictive value and appears to be a more promising serum marker in outcome prediction after severe head injury.     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

老年患者髋关节置换术后早期认知功能障碍的因素分析

目的 分析影响老年患者髋关节置换术后早期认知功能障碍(POCD)的因素.方法 择期髋关节置换术老年患者33例,随机分为2组:静吸复合全麻组(G组,n=15)和脊椎.硬膜外麻醉组(E组,n=18).术中收缩压波动幅度不超过基础值的25%,SpO2≥95%.术后48 h静脉输注0.001%芬太尼2 ml/h镇痛.于麻醉诱导前、术后3 h、6 h、1 d、3 d时记录MMSE评分;采集颈内静脉血样,测定血清S-100β蛋白及神经元特异性烯醇化酶(NSE)浓度.计算麻醉诱导前MMSE评分的标准差,每例患者以麻醉诱导前评分为对照,术后评分与麻醉诱导前比较≥1个标准差时即判断发生POCD.根据术后3 h有无POCD分为POCD组(A组)和无POCD组(B组).结果 E组术后3 h时POCD发生率(22%)低于G组(67%)(P＜0.05).与麻醉诱导前比较,G组和A组术后3、6 h、1 d时、E组和B组术后3、6 h时S-100β蛋白和NSE浓度均升高(P＜0.05或0.01);与术后3 h比较.4组术后其余时点S-100β蛋白浓度均降低,G组和B组术后3 d时NSE浓度降低(P＜0.01);与G组比较,E组术后3 h时NSE浓度降低(P＜0.05);与A组比较,B组术后3 h时S-100β蛋白浓度降低,术后6 h时NSE浓度降低(P＜0.05或0.01).结论 髋关节置换术老年患者行全身麻醉较行脊椎.硬膜外麻醉术后早期POCD发生率高,且与S-100β蛋白和NSE浓度的升高有关.     

二次全膝关节置换术对老年患者术后早期认知功能的影响

目的 通过观察首次及二次全膝关节置换术术后早期认知功能及炎性细胞因子的变化,探讨二次全膝关节置换术对老年患者术后早期认知功能的影响. 方法 择期行全膝关节置换术患者96例,年龄≥65岁,ASA分级Ⅰ、Ⅱ级,按手术次数分为一次手术组和二次手术组,每组48例.采用简易精神状态检查(mini-mental state examination,MMSE)量表于术前及术后1、3、5、7d进行认知功能评估.术后MMSE评分较术前降低大于或等于一个标准差为发生术后认知功能障碍(postoperative cognitive dysfunction,POCD).根据是否发生POCD分为POCD组和NPOCD组.于麻醉诱导前、术后24h抽取外周静脉血,应用ELISA测定IL-1、IL-6和IL-10的浓度. 结果 二次手术组患者术后3、5 d POCD的发生率(56.3％、10.4％)显著高于一次手术组(25.0％、2.1％)(P＜0.05).与NPOCD组比较,POCD组术后IL-6的水平较术前明显增加,术后IL-10的水平较术前明显降低,差异有统计学意义(P＜0.05).与术前比较,一次手术组和二次手术组POCD患者术后24 h IL-6的水平明显增加(P＜0.05)、IL-10的水平明显降低(P＜0.05);与一次手术组POCD患者比较,二次手术组POCD患者术后24 h IL-6的水平明显升高(P＜0.05)、IL-10的水平明显降低(P＜0.05). 结论 二次全膝关节置换术老年患者术后早期POCD发生率增加,可能与血液中IL-6浓度升高及IL-10浓度降低有关.     

Serum concentration of S-100 protein in assessment of cognitive dysfunction after general anesthesia in different types of surgery

BACKGROUND: S-100 protein serum concentration (S-100) serves as a marker of cerebral ischemia in cardiac surgery, head injury and stroke. In these circumstances S-100 corresponds well with the results of neuropsychological tests. The aim of the present study was to investigate the value of S-100 and neuron specific enolase (NSE) in reflecting postoperative cognitive deficit (POCD) after general surgical procedures. METHODS: One hundred and twenty patients undergoing vascular, trauma, urological or abdominal surgery were investigated. Serum values of S-100 and NSE were determined preoperatively and 0.5, 4, 18 and 36 h postoperatively. Neuropsychological tests for detecting POCD were performed preoperatively and on day 1, 3, and 6 after the operation. A decline of more than 10% in neuropsychological test results was regarded as POCD. Furthermore, we retrospectively compared the S-100 in patients with and without POCD in different types of surgery. RESULTS: According to our definition, forty-eight patients had POCD (95% confidence interval: 37.5-58.5). These patients showed higher serum concentrations of S-100 (median 024 ng/ml; range 0.01-3.3 ng/ml) compared with those without POCD (n=69; median 0.14 ng/ml; range 0-1.34 ng/ml) 30 min postoperatively (P=0.01). Neuron specific enolase was unchanged during the course of the study. Differences of S-100 in patients with and without POCD were found in abdominal and vascular surgery but not in urological surgery. CONCLUSION: When all patients are pooled, S-100 appears to be suitable in the assessment of incidence, course and outcome of cognitive deficits. We suspect that in some surgical procedures, such as urological surgery, S-100 appears to be of limited value in detecting POCD. Neuron specific enolase did not reflect neuropsychological dysfunction after noncardiac surgery.     

Diagnostischer Wert des S-100-Proteins und der Neuronenspezifischen Enolase als Serummarker zerebraler Störungen nach Allgemeinnarkosen Untersuchung nach Hüft- und Kniegelenkersatz

S-100 protein and neuron-specific enolase (NSE) serum concentrations serve as markers of cerebral damage in cardiac surgery, neurology, or after head injury. In these circumstances, S-100 and NSE levels correspond with the results of neuropsychological tests. The present study investigated the diagnostic value in orthopaedic patients after joint replacement. METHODS: Forty patients scheduled for elective hip or knee arthroplasty were investigated. Serum values of NSE and S-100 were determined preoperatively and 30 min and 4, 18, and 36 h postoperatively. Neuropsychological tests (syndrome short test, SKT, delirium assessment according to DSM IV) were performed preoperatively and two, three, and four days following surgery. General anaesthesia was induced with fentanyl and etomidate and maintained with isoflurane in oxygen/air. FINDINGS: The S-100 increased from a median of 0.04 ng/ml (range 0.004-0.19 ng/ml) preoperatively to 1.03 ng/ml (range 0.18-3.65 ng/ml) at 30 minutes postoperatively (P < 0.0001). These levels returned to normal in the course of the following 2 days. NSE values were 8.55 ng/ml (range 4.6-14.9 ng/ml) preoperatively and 7.07 ng/ml (range 4-16.4 ng/ml) postoperatively (P = 0.167). There were no differences in serum concentrations of S-100 and NSE between normal patients and those with postoperative cognitive deficit. Furthermore, no correlation was found between the serum marker and neuropsychological tests. INTERPRETATION: Obviously, increased NSE levels seem to indicate cerebral damage only in more severe cases. S-100 does not seem to be brain-specific in patients undergoing orthopaedic surgery. Therefore, the value of S-100 in the assessment of brain disorders is limited.     

Early postoperative cognitive dysfunction is associated with higher cortisol levels in aged patients following hip fracture surgery

This study aimed to evaluate the relationship between plasma cortisol levels and the occurrence of postoperative cognitive dysfunction (POCD) in aged patients following hip fracture surgery. A total of 175 patients, aged 65 years or older, who were scheduled for hip fracture surgery with spinal anesthesia were enrolled. Perioperative plasma levels of cortisol and neurocognitive tests were determined at 1 day preoperatively and 7 days postoperatively. Seventy-seven patients completed both blood sample collections and neurocognitive tests. POCD occurred in 29.9 % of patients at 7 days postoperatively. POCD patients presented significantly higher cortisol levels compared with non-POCD patients (P < 0.05). Furthermore, plasma cortisol levels were negatively correlated with mini-mental state examination (MMSE) scores at 7 days postoperatively (P < 0.0001). A specificity of 93 % and a sensitivity of 35 % were identified for the plasma cortisol measurement to discriminate POCD patients from non-POCD patients. The results suggest higher plasma cortisol levels are associated with POCD in aged patients following hip fracture surgery with spinal anesthesia.     

Perioperative plasma concentrations of stable nitric oxide products are predictive of cognitive dysfunction after laparoscopic cholecystectomy

In this study our objectives were to determine the incidence of postoperative cognitive dysfunction (POCD) after laparoscopic cholecystectomy under sevoflurane anesthesia in patients aged >40 and <85 yr and to examine the associations between plasma concentrations of i) S-100beta protein and ii) stable nitric oxide (NO) products and POCD in this clinical setting. Neuropsychological tests were performed on 42 ASA physical status I-II patients the day before, and 4 days and 6 wk after surgery. Patient spouses (n = 13) were studied as controls. Cognitive dysfunction was defined as deficit in one or more cognitive domain(s). Serial measurements of serum concentrations of S-100beta protein and plasma concentrations of stable NO products (nitrate/nitrite, NOx) were performed perioperatively. Four days after surgery, new cognitive deficit was present in 16 (40%) patients and in 1 (7%) control subject (P = 0.01). Six weeks postoperatively, new cognitive deficit was present in 21 (53%) patients and 3 (23%) control subjects (P = 0.03). Compared with the "no deficit" group, patients who demonstrated a new cognitive deficit 4 days postoperatively had larger plasma NOx at each perioperative time point (P < 0.05 for each time point). Serum S-100beta protein concentrations were similar in the 2 groups. In conclusion, preoperative (and postoperative) plasma concentrations of stable NO products (but not S-100beta) are associated with early POCD. The former represents a potential biochemical predictor of POCD.     

老年患者肠癌切除术后早期认知功能障碍的危险因素

目的 筛选老年患者肠癌切除术后早期认知功能障碍(POCD)的危险因素.方法 择期拟行肠癌切除术老年患者120例,年龄≥65岁,性别不限,ASA分级Ⅱ或Ⅲ级.根据患者术后第7天是否发生POCD,将其分为POCD组和非POCD组.记录患者年龄、体重、性别、受教育程度、肿瘤部位、TNM分期、合并疾病、术前中医证型、术前ld、术后l、3、7d的MMSE评分、麻醉时间、苏醒时间、术中出血量及出现低血压次数.采用logistic回归分析法筛选POCD的危险因素.结果 术后35例患者发生POCD,发生率为29.2％.Logistic回归分析结果显示:年龄、受教育程度、肿瘤部位及术中出现低血压次数为老年患者肠癌切除术后发生POCD的危险因素(P＜0.05).结论 年龄、受教育程度、肿瘤部位和术中出现低血压次数是老年患者肠癌切除术后早期发生POCD的危险因素.     

依达拉奉预处理对老年骨科手术患者炎症相关因子与术后早期认知功能障碍的影响

【摘要】 目的 观察依达拉奉预处理对老年骨科手术患者炎症相关因子反应及术后早期认知功能的影响,探讨其降低术后早期认知功能障碍(POCD)的可行性。方法〓选择择期全麻下行髋关节手术患者60例,年龄≥65岁,ASA评级Ⅰ~Ⅲ级。分为依达拉奉预注组(E组,n=30例)和对照组(C组,n=30例)。分别在麻醉诱导后(T1)、手术结束时(T2)、术后24小时(T3)经颈内静脉抽取静脉血,测定IL-6、IL-10、TNF-?琢,及检测S100-β蛋白。选用简易智能状态检查量表(MMSE)评估术前1天,术后第1天和术后第7天认知状态,术后MMSE评分较术前下降≥2分评定POCD发生。结果〓两组患者中,与T1比较,T2~T3的IL-6、IL-10、TNF-?琢、S100-β水平明显升高(P均<0.05)。与C组比较,T3时E组患者IL-6、TNF-?琢水平明显降低(P均<0.05);T2~T3时E组患者S100-β水平也明显降低(P<0.05,与C组比较)。两组患者中,与术前1天比较,术后第1天MMSE评分明显降低(P均<0.05)。与C组比较,E组术后第1天MMSE评分明显增高(P<0.05)。E组发生POCD有4例,明显少于C组的9例(P<0.05)。结论 依达拉奉预处理应用于老年骨科手术患者,能一定程度抑制炎症相关因子水平,减少术后早期认知功能障碍的发生。     

七氟醚预处理对非体外循环下冠状动脉旁路移植术患者术后早期认知功能的影响

目的评价七氟醚预处理对非体外循环下冠状动脉旁路移植术（off-pump coronary artery bypass, OPCABG）患者术后早期认知功能的影响。方法择期行OPCABG的患者60例,年龄55岁～75岁,ASA分级Ⅱ、Ⅲ级,采用随机数字表法分为两组（每组30例）：七氟醚预处理组（s组）和丙泊酚组（P组）。s组在手术开始时吸入1．0％～2．0％七氟醚,持续30min,维持同P组,其余麻醉措施两组相同。于麻醉诱导后即刻（T0）、关胸后（T1）、术后6h（T2）、术后12h（T3）、术后24h（T4）等5个时点采集颈内静脉球部血3ml,测定血清神经特异性烯醇化酶（neurone specific enolasc,NSE）、S100β蛋白、超氧化物歧化酶（superoxide dismutase,SOD）浓度。分别于术前1d和术后3d、7d、3个月对患者进行简易精神状态量表（min-mental stateexamination,MMSE）测验。结果与T0比较,两组患者于T1～B时血清S100β蛋白、NSE浓度显著增高（P〈0．05）,而在T4时差异无统计学意义（P〉0．05）;S组患者血清SOD浓度在T1-T2时与T0时比较,差异无统计学意义（P〉0．05）,而在T3-T4时显著增高（P〈0．05）,P组患者血清SOD浓度在T1-T4时与T0时比较,差异无统计学意义（P〉0．05）。两组间比较,P组血清s100β蛋白、NSE浓度在T1-T2时显著高于s组（P〈0．05）,而在T3～T4时比较,差异无统计学意义（P〉0．05）;两组间血清SOD浓度在T1-T2时比较,差异无统计学意义（P〉0．05）,而在T3～T4时P组显著低于S组（P〈0．05）.S组术后3d、7dMMSE评分明显低于术前1d（P〈0．05）,而术后3个月MMSE评分与术前1d比较,差异无统计学意义（P〉0．05）;P组患者术后3d、7d、3个月MMSE评分较术前1d均明显降低（P〈0．05）;两组间比较,s组患者术后3d、7d、3个月MMSE评分显著高于P组（P〈0．05）,s组术后3d、7d、3个月术后认知功能障碍（postoperative cognitive dysfunction,POCD）的发生率明显低于P组（P〈0．05）.结论七氟醚预处理减轻OPCABG患者术后脑损伤程度,可预防和降低POCD的发生。     

控制性降压联合穴位电刺激对术后认知功能障碍的影响

目的：探讨七氟烷麻醉下以硝酸甘油行控制性降压联合穴位电刺激对术后认知功能障碍的影响。方法：选择ASAⅠ～Ⅲ级,45～65岁行单节段腰椎切开复位内固定手术患者75例,随机分为穴位刺激联合硝酸甘油控制性降压组（T组,n=36）及单纯硝酸甘油控制性降压组（N组,n=39）,分别给予相应的治疗。结果：术后1、3dT组术后认知功能障碍发生率较N组明显降低（P〈0.05,P〈0.01）;5d发生率两组无显著差异（P〉0.05）。术后各时间点两组患者血清S-100β浓度均较术前升高（P〈0.05,P〈0.01）。术后1、3dT组血清S-100β较N组明显减低（P〈0.05,P〈0.01）,术后5d两组无显著差异。结论：七氟烷麻醉下行控制性降压联合经皮穴位电刺激可降低术后认知功能障碍的发生率。