术前应用石杉碱甲对老年患者术后认知功能的影响

目的 观察石杉碱甲对老年患者手术后认知功能的影响.方法 80例拟行腹腔镜胆囊切除术的老年患者,年龄65～75岁,美国麻醉医师协会(ASA) Ⅰ-Ⅱ级,随机分为观察组和对照组,每组40例.两组分别在术前3d每天静脉注射石杉碱甲0.2mg或等量生理盐水.术后恢复期记录患者苏醒时间,并分别于术前,术后3h、6h、24h、3d、1周采用简易智能量表(MMSE)评估患者认知功能,测定血清S100β蛋白水平.结果 两组患者术后MMSE评分均较术前有不同程度下降,观察组苏醒时间(23±3min)短于对照组(31±5min,P＜0.05)；观察组MMSE评分术后3h、6h、24h、3d分别为19.2±1.4、20.3±1.5、22.4±1.6、24.2±1.6,明显高于对照组(16.5±1.3、17.3±1.3、18.8±1.4、21.5±1.4,P＜0.05).观察组术后3h、6h、24h发生认知功能障碍的患者少于对照组(分别为2、4、2和9、11、8例,P＜0.05).观察组术后有1例发生谵妄,明显少于对照组(6例,P＜0.05).两组S100 β蛋白测定值术后3、6h均较术前明显上升(P＜0.01),且观察组术后3、6、24h S100 β蛋白测定值低于对照组(P＜0.05).结论 石杉碱甲可降低老年手术患者术后认知功能障碍(POCD)的发生率.

Effects of preoperative application of huperzine A on postoperative cognitive function in elderly patients

Objective To observe the influence of huperzine A on postoperative cognitive function in elderly patients.Methods Eighty patients,aged 65 to 75,American Society of Anesthesiologists(ASA) grade Ⅰ to Ⅱ,undergoing laparoscopic cholecystectomy,were randomly divided into experimental group and control group.Forty cases were assigned to each group.The experimental group and the control group were intravenously injected with 0.2mg each of huperzine A or normal saline everyday for 3d before operation.The awakening time of the patient after operation was recorded.Mini mental state examination(MMSE) was used to assess the cognitive function of the patients before the operation and 3h,6h,24h,3d,and 1 week after the operation.In addition,protein S100β levels in the serum before operation and 3h,6h,24h,3d,and 1 week after the operation were determined.Results The MMSE scores of both groups were lower after operation than that of preoperative in different degrees.The awakening time of experimental group(23±3min) was shorter than that of the control group(31±5min,P<0.05).The MMSE scores at 3h,6h,24h,and 3d after operation were 19.2±1.4,20.3±1.5,22.4±1.6,and 24.2±1.6 respectively in the experimental group,and they were noticeably higher than those of the control group(16.5±1.3,17.3±1.3,18.8±1.4,and 21.5±1.4,respectively,P<0.05).The incidence of postoperative cognitive dysfunction(POCD) was lower in the experimental group than in the control group at 3,6,and 24h after the operation(2,4,and 2 and 9,11,and 8 cases respectively,P<0.05).Postoperative delirium occurred in one patient in the experimental group,and it was lower than that in the control group(6 cases,P<0.05).S100β protein values increased at 3 and 6h in both groups(P<0.01),while the values at 3,6,and 24 h in the experimental group were lower than those in the control group(P<0.05).Conclusion Huperzine A injection could lower the incidence of PODC in elderly patients.