本文選題：老年人　切入點(diǎn)：人格　出處：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的:明確不同人格維度與老年人胃腸外科術(shù)后認(rèn)知功能障礙（POCD）的關(guān)系，為預(yù)測老年人術(shù)后認(rèn)知功能障礙提供參考，為預(yù)防老年人術(shù)后認(rèn)知功能障礙提供可能的方法。 方法:依據(jù)納入排除標(biāo)準(zhǔn)選擇擇期全麻下行腹部胃腸手術(shù)的老年患者65例，年齡65~70歲。所有患者均采用全身麻醉，且不使用術(shù)前藥物。入室后監(jiān)測心電圖，心率，血氧飽和度，BIS，局麻下行橈動脈穿刺、中心靜脈穿刺并監(jiān)測有創(chuàng)動脈壓。用靜脈注射芬太尼4μg/kg、依托咪酯150~300μg/kg使BIS降至40~60、順阿曲庫銨0.2mg/kg進(jìn)行麻醉誘導(dǎo)，3min后行氣管插管并機(jī)械通氣。呼吸參數(shù)設(shè)置為潮氣量6~8ml/kg，調(diào)節(jié)呼吸頻率使呼末二氧化碳維持在35~40mmHg。麻醉維持：靜脈泵注瑞芬太尼4~8μg·kg-1·h-1，呼末七氟烷濃度2%~2.5%，維持BIS在40~60之間，間斷給予順阿曲庫銨維持肌松。手術(shù)結(jié)束前30min靜脈注射芬太尼1μg/kg，術(shù)畢停用麻醉藥物。避免使用已知的可能會引起認(rèn)知功能下降的藥物包括，異氟烷，阿托品，咪達(dá)唑侖等。符合拔管標(biāo)準(zhǔn)后拔除氣管導(dǎo)管，監(jiān)測生命體征平穩(wěn)送返外科監(jiān)護(hù)病房。于術(shù)后4h及24h對患者進(jìn)行視覺模擬評分（visual analogue scale，VAS），對VAS≥3分的患者給予曲馬多50mg靜脈注射，15分鐘后再行評估及處理，直至患者VAS評分＜3分為止。術(shù)前一天對患者進(jìn)行艾森克人格問卷（EPQ），記錄患者不同人格維度得分，并由同一位心理醫(yī)師在術(shù)前一天和術(shù)后第七天對患者進(jìn)行神經(jīng)心理測試，判斷患者是否發(fā)生POCD。記錄患者的一般資料及手術(shù)時(shí)間，麻醉時(shí)間，文化程度，合并癥（包括糖尿病、高血壓、冠心病、貧血），吸煙史，飲酒史，是否應(yīng)用新輔助化療，術(shù)后是否發(fā)生譫妄，對所有因素進(jìn)行多因素Logistic回歸分析，探討人格維度與POCD的關(guān)系。 結(jié)果:65例患者中有57例完成試驗(yàn)，其中10例發(fā)生POCD，發(fā)生率為17．86%。兩組患者年齡、性別構(gòu)成比、麻醉時(shí)間、手術(shù)時(shí)間均無統(tǒng)計(jì)學(xué)差異.多因素Logistic回歸分析顯示：P等級、L等級、性別、文化程度、貧血分級、是否吸煙、是否飲酒、是否輸血、是否應(yīng)用新輔助化療、是否發(fā)生譫妄等因素與POCD發(fā)生沒有相關(guān)性，E、N等級是POCD的危險(xiǎn)因素，E、N等級每增高一個(gè)級別POCD發(fā)生率分別增高4.76倍和8.17倍，其回歸系數(shù)分別為0.681、0.716。Logistic回歸方程為：Log（P）=-10.772+2.101N+1.561E。用該方程預(yù)測POCD，其陽性預(yù)測值（PositivePredictive Value，PPV）為100%，，陰性預(yù)測值（Negative Predictive Value，NPV）為92.3%，靈敏度（sensitivity）為60%，特異度（specificity）為100%， 結(jié)論:情緒穩(wěn)定性差，性格外向的患者發(fā)生術(shù)后認(rèn)知功能障礙的風(fēng)險(xiǎn)高。
[Abstract]:Objective: to determine the relationship between different personality dimensions and cognitive dysfunction (POCD) in elderly patients after gastrointestinal surgery, and to provide a reference for predicting postoperative cognitive dysfunction in the elderly and to provide a possible method for preventing postoperative cognitive dysfunction in the elderly. Methods: 65 elderly patients, aged 65 to 70 years, undergoing abdominal gastrointestinal surgery under general anesthesia were selected according to the exclusion criteria. All patients were treated with general anesthesia, and no drugs were used before operation. Electrocardiogram (ECG) and heart rate (HR) were monitored after entering the room. Blood oxygen saturation (BIS), radial artery puncture under local anesthesia, Central venipuncture was performed and invasive arterial pressure was monitored. Intravenous injection of fentanyl (4 渭 g / kg) and etomidate (150 渭 g/kg) reduced the BIS to 40,60,3 minutes after anesthesia induction with cisatracurium 0.2mg/kg, tracheal intubation and mechanical ventilation were performed. The respiratory parameters were set as tidal volume of 6ml / kg. Anesthesia maintenance: intravenous infusion of remifentanil 48 渭 g kg-1 h-1, final sevoflurane concentration 2 and 2.5%, maintenance of BIS between 40 and 60, 30min was intravenously injected with fentanyl 1 渭 g / kg before surgery, and the anesthetic was stopped after surgery. Avoiding the use of drugs known to cause cognitive impairment included isoflurane and atropine. Midazolam, etc. Tracheal catheter is removed after meeting the extubation standard, The visual analogue score and visual analogue scale were performed at 4 and 24 hours after operation. Patients with VAS 鈮

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