本文選題：認知障礙　切入點：全身麻醉　出處：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的術(shù)后認知功能障礙(postoperative cognitive dysfunction POCD)作為一種術(shù)后常見并發(fā)癥,在高齡患者的術(shù)后較非高齡患者中存在較高的發(fā)生率。其損害患者的認知功能包括記憶力、注意力及執(zhí)行功能等,深深影響患者的術(shù)后日常生活。目前已知其發(fā)生與多種因素包括手術(shù)類型、麻醉方式年齡等相關(guān),而對于其確切發(fā)病機制及診斷標準尚不明確,因此研究早期認知功能改變至關(guān)重要。血管內(nèi)皮生長因子(vascular endothelial growth factors VEGF)又稱血管通透性因子,人們最初發(fā)現(xiàn)VEGF作為一種最強的血管生成因子,其通過和血管內(nèi)皮生長因子受體(vascular endothelial growth factors receptor VEGFR)結(jié)合可以誘導內(nèi)皮細胞增殖以及遷移生長,從而形成新的血管網(wǎng)并因此命名為血管生長因子。近年來發(fā)現(xiàn),在中樞神經(jīng)系統(tǒng)中,其可以營養(yǎng)神經(jīng)并起到神經(jīng)保護的作用。血流動力異常改變及缺血缺氧狀態(tài)均可誘發(fā)VEGF表達量的增加,并促進新的血管的再生。目前對于患者的認知功能的與其外周靜脈血VEGF的改變是否相關(guān)知之甚少。我們假設(shè)術(shù)后認知功能下降與血管內(nèi)皮生長因子的變化存在相關(guān)性。本課題研究在目的于探討氣管插管全麻老年患者外周血VEGF和早期認知功能下降的相關(guān)性,為臨床早期預(yù)防術(shù)后認知功能障礙提供可能的監(jiān)測指標。方法首先選擇老年骨科手術(shù)患者,年齡≥65歲,無心腦血管疾病和精神類藥物使用史。對患者術(shù)前和術(shù)后采用簡易智能精神狀態(tài)檢查表(mini-mental state examination MMSE)進行認知評分,以此明確患者認知功能狀況。然后根據(jù)患者術(shù)前、術(shù)后評分差異將實驗對象分為兩組:實驗組或認知功能下降組20例,以及對照組22例。對于術(shù)后2h認知功能評分比術(shù)前1d下降≥2分的患者被劃分為實驗組,術(shù)后2h認知功能評分比術(shù)前1d無改變或增加為1分的患者被分為對照組。另外,本實驗分別于麻醉誘導前15min(T0),術(shù)中1h(T1),術(shù)后2h(T2),術(shù)后1d(T3)四個時間點采取少量靜脈血,然后依據(jù)酶聯(lián)免疫吸附劑測定(enzyme-linked immunosorbent assay,ELISA)的原理采用雙抗體夾心ELISA法檢測患者外周血VEGF的表達水平。結(jié)果實驗組及對照組兩組老年患者一般情況無顯著性差異,術(shù)中生命體征、輸液量以及麻醉藥物劑量無顯著性差異。實驗組術(shù)后2h MMSE評分與術(shù)前1天評分比較有顯著差異(P0.001),而對照組MMSE量表評分在術(shù)前與術(shù)后差異不明顯。對于兩組患者外周血VEGF值的變化,試驗組與對照組外周血VEGF值在全麻誘導前15min(T0)與術(shù)中1h(T1)兩組間無明顯差異,而實驗組與對照組術(shù)后2h VEGF表達值有顯著差異(P㩳0.01)且實驗組的表達量明顯高于對照組。兩組在術(shù)后1d(T3)也未見明顯差異。結(jié)論骨科老年患者全麻手術(shù)后2小時術(shù)后認知功能下降的發(fā)生與術(shù)后2小時外周血血管內(nèi)皮生長因子表達水平升高相關(guān)。
[Abstract]:Objective as a common postoperative complication, postoperative cognitive dysfunction (PC) has a higher incidence in the elderly patients than in the younger ones. The cognitive impairment of the patients includes memory, attention and executive function. It is known that its occurrence is related to many factors, such as the type of operation, the age of anesthesia, and so on, but the exact pathogenesis and diagnostic criteria are not clear. Therefore, it is important to study early cognitive changes. Vascular endothelial growth factors VEGF, also known as vascular permeability factor, was initially found to be the strongest angiogenic factor. It can induce the proliferation and migration of endothelial cells by binding to vascular endothelial growth factors receptor VEGF, thus forming a new vascular network and hence the name of vascular growth factor. In recent years, it has been found that in the central nervous system, It can nourish the nerve and play a neuroprotective role. Abnormal changes of blood flow and ischemia and hypoxia can induce the increase of VEGF expression. At present, little is known about whether the cognitive function of patients is related to the changes of VEGF in their peripheral venous blood. We assume that the decline of cognitive function after operation is related to the changes of vascular endothelial growth factor (VEGF). The purpose of this study was to investigate the correlation between peripheral blood VEGF and early cognitive impairment in elderly patients with tracheal intubation under general anesthesia. Methods the elderly patients with orthopedic surgery were selected as the first choice, aged 鈮，

本文編號：1681752