發(fā)布時(shí)間：2018-04-28 11:23

  本文選題：術(shù)后認(rèn)知障礙 + 老年病人�。� 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：術(shù)后認(rèn)知功能障礙(Postoperative cognitive dysfunction, POCD)是術(shù)后精神功能障礙(Postoperative psychonosema,POP)的一種臨床表現(xiàn),也是老年患者術(shù)后常見(jiàn)的一種中樞神經(jīng)系統(tǒng)的并發(fā)癥。表現(xiàn)為麻醉手術(shù)后記憶力、定向力、抽象思維能力障礙,同時(shí)伴有社會(huì)活動(dòng)能力的減退,即人格、社交能力及認(rèn)知能力和技巧的改變。隨著老齡化逐漸成為中國(guó)發(fā)展的趨勢(shì),老年病人越來(lái)越多,盡管由于醫(yī)療技術(shù)水平和診療手段的提高使圍手術(shù)期死亡率和多數(shù)嚴(yán)重并發(fā)癥的發(fā)生率大大的降低,但是并沒(méi)有明顯改善對(duì)術(shù)后精神功能障礙的發(fā)生率。本研究旨在觀察不同藥物用于老年病人術(shù)后鎮(zhèn)痛的效果及對(duì)認(rèn)知功能的影響。目的比較舒芬太尼、氟比洛芬酯聯(lián)合舒芬太尼分別用于老年人術(shù)后鎮(zhèn)痛的鎮(zhèn)痛效果以及對(duì)術(shù)后認(rèn)知功能障礙的影響,旨在為老年患者探討一種安全、有效的術(shù)后鎮(zhèn)痛方法。方法選取普外科腹部手術(shù)(剔除腹腔鏡手術(shù))患者120例,ASAⅠ～Ⅲ級(jí),排除神經(jīng)統(tǒng)系疾病、精神病病史,年齡65-82歲,手術(shù)時(shí)間(117.9±53.63) min以?xún)?nèi),麻醉方法為全身麻醉。隨機(jī)分為兩組(n=60)：舒芬太尼組(Ⅰ組)、舒芬太尼-氟比洛芬酯組(Ⅱ組)�；颊咝g(shù)后清醒拔出氣管導(dǎo)管(或者喉罩)后1小時(shí),接入經(jīng)靜脈患者自控鎮(zhèn)痛(Patient controlled intravenons analgesia, PCIA)泵鎮(zhèn)痛。鎮(zhèn)痛泵自控鎮(zhèn)痛,背景劑量：4ml/h,按壓劑量：3ml,鎖定時(shí)間：15 min。舒芬太尼組(Ⅰ組)在鎮(zhèn)痛泵中加入舒芬太尼2.5μg/kg+0.9%生理鹽水200 ml;氟比洛芬酯-舒芬太尼組(Ⅱ組)在鎮(zhèn)痛泵中加入氟比洛芬酯25 mg/kg+舒芬太尼1μg/kg+0.9%生理鹽水200ml。在術(shù)前24小時(shí)(To),術(shù)后6小時(shí)(T1),術(shù)后24小時(shí)(T2),術(shù)后48小時(shí)(T3)各時(shí)間點(diǎn)分別進(jìn)行MMSE和VAS評(píng)分及血液中p-淀粉樣蛋白(Aβ)水平測(cè)定,并記錄評(píng)分結(jié)果,并同時(shí)記錄四個(gè)時(shí)間點(diǎn)的MAP、HR、SpO2,以及患者術(shù)后每日自行按壓經(jīng)靜脈自控鎮(zhèn)痛泵的次數(shù)。結(jié)果兩組患者年齡、身高、體重、性別、手術(shù)時(shí)間、術(shù)前24小時(shí)MMSE評(píng)分、麻醉ASA分級(jí)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。組內(nèi)比較：與To比較,Ⅰ組、Ⅱ組在T1、T2、T3各時(shí)點(diǎn)的平均動(dòng)脈壓(Mean arterial press,MAP)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；與To比較,Ⅰ組、Ⅱ組在T1、T2、T3各時(shí)點(diǎn)的心率(Heart rate,HR)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；與T0比較,Ⅰ組、Ⅱ組T1、T2、T3各時(shí)點(diǎn)的血氧飽和度(SpO2)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；與T0比較,Ⅰ組、Ⅱ組T1、T2、T3各時(shí)點(diǎn)的MMSE評(píng)分降低。差異有統(tǒng)計(jì)學(xué)意義(P0.05);與T0較比,Ⅰ組、Ⅱ組T1、T2、T3各時(shí)點(diǎn)的VAS升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；與T0較比,Ⅰ組、ⅡⅡ組T1、T2、T3各時(shí)點(diǎn)的血液中p-淀粉樣蛋白(Ap)水平均有所升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。組間比較平均動(dòng)脈壓(MAP)比較：與Ⅰ組比較,Ⅱ組在T1、T2、T3各時(shí)點(diǎn)MAP降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；心率(HR)比較：與Ⅰ組比較,Ⅱ組在T1、T2、T3各時(shí)點(diǎn)HR較高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；血氧飽和度(SpO2)比較：與Ⅰ組比較,Ⅱ組的SpO2在T1、T2、T3三個(gè)時(shí)間點(diǎn)的數(shù)值都較高；差異有統(tǒng)計(jì)學(xué)意義(P0.05)；VAS評(píng)分比較：,與Ⅰ組比較,Ⅱ組在To時(shí)間點(diǎn)的VAS評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；與Ⅰ組比較,Ⅱ組在術(shù)后T1、T2、T3各時(shí)點(diǎn)的VAS評(píng)分降低(P0.05)。MMSE比較：與Ⅰ組比較,Ⅱ組在T0時(shí)點(diǎn)的MMSE評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。與Ⅰ組比較,Ⅱ組在T1、T2、 T3各時(shí)點(diǎn)的MMSE評(píng)分較高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);血液中β-淀粉樣蛋白(Aβ)水平比較：與Ⅰ組比較,Ⅱ組在To時(shí)點(diǎn)的血液中p-淀粉樣蛋白(Ap)水平比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。與Ⅰ組比較,Ⅱ組在T1、T2、T3各時(shí)點(diǎn)的血液中p-淀粉樣蛋白(Aβ)水平較低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；自控鎮(zhèn)痛泵每12小時(shí)自行按壓的次數(shù)比較：與Ⅰ組比較,Ⅱ組每日按壓次數(shù)較多,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論氟比洛芬酯聯(lián)合舒芬太尼用于老年病人術(shù)后鎮(zhèn)痛其鎮(zhèn)痛效果良好,優(yōu)于舒芬太尼單獨(dú)用于老年病人術(shù)后鎮(zhèn)痛的鎮(zhèn)痛效果。氟比洛芬酯聯(lián)合舒芬太尼用于老年病人術(shù)后鎮(zhèn)痛在一定程度上減少不良反應(yīng)的發(fā)生,同時(shí)也可以在一定程度上明顯降低術(shù)后認(rèn)知功能障礙的發(fā)生率。
[Abstract]:Postoperative cognitive dysfunction (Postoperative cognitive dysfunction, POCD) is a clinical manifestation of postoperative mental dysfunction (Postoperative psychonosema, POP). It is also a common complication of the central nervous system after the operation of the elderly. It is manifested in memory, orientation, and abstract thinking ability after anaesthesia. The decline in social activity, namely, personality, social ability and cognitive ability and skills, is becoming a trend in the development of China, with more and more elderly patients, although the rate of perioperative mortality and the incidence of most serious complications is greatly reduced, although the level of medical technology and diagnosis and treatment have greatly reduced the incidence of most serious complications. The purpose of this study was to observe the effect of different drugs on postoperative analgesia and cognitive function in elderly patients. Objective to compare the analgesic effects of sufentanil, flurbiprofen and sufentanil for postoperative analgesia and cognitive dysfunction after operation. The purpose of this study was to explore a safe and effective postoperative analgesia for the elderly patients. Methods 120 cases of abdominal surgery (excluding laparoscopy) in the Department of general surgery were selected, 120 patients were removed from the laparoscopy, ASA I to grade III, excluding the neurologic disease, the history of psychosis, the age of 65-82 years, the operation time (117.9 + 53.63) min, and general anesthesia. The anesthesia was divided into two randomly. Group (n=60): sufentanil group (group I), sufentanil - flurbiprofen group (Group II). Patients were sober out of the tracheal tube (or laryngeal mask) after 1 hours after surgery, access the intravenous patient-controlled analgesia (Patient controlled Intravenons analgesia, PCIA) pump analgesia. Analgesic pump self-control analgesia, the background dose: 4ml/h, compression dose: 3ml, locking time Room: 15 min. sufentanil group (group I) added sufentanil 2.5 Mu physiological saline 200 ml in the analgesia pump; flurbiprofen sufentanil group (Group II) added flurbiprofen ester 25 mg/kg+ sufentanil 1 ufentanil 1 u g/kg+0.9% physiological saline 200ML. at 24 hours before operation (To), 6 hours after operation (T1), 24 hours postoperative (T2), 48 small after operation. MMSE and VAS scores and the level of p- amyloid protein (A beta) in blood were measured at all time points (T3), and the results were recorded, and MAP, HR, SpO2, and the times of self controlled intravenous analgesia by self controlled intravenous analgesia were recorded at the same time at four time points. Results the age, height, weight, sex, operation time, 24 of the two groups were 24. Compared with To, group I, group I, group I, group I, group I and group II were compared with the mean arterial pressure (Mean arterial press, MAP) at T1, T2, T3, and there was no statistical difference (P0.05), compared to group I, group I, group I, group I, group I, group I, P0.05, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference between MMSE and To. There was no statistical significance (P0.05); compared with T0, there was no statistical difference between group I, group II, T1, T2, and T3 at each time point of blood oxygen saturation (SpO2). Compared with T0, the MMSE scores of group I, group I, T1, T2, T3 were lower. Learning significance (P0.05); compared with T0, the level of p- amyloid protein (Ap) in the blood of group I and II II group T1, T2, T3 all increased, the difference was statistically significant (P0.05). Compared with the group I compared with the group I, the group II was lower in T1, T2, and T3 at each time point, and the difference was statistically significant. Compared with group I, group II was higher at T1, T2 and T3 at each time point, and the difference was statistically significant (P0.05); oxygen saturation (SpO2) was compared. Compared with group I, the value of SpO2 in the three time points of T1, T2, T3 in group II was higher; the difference was statistically significant (P0.05); the VAS score was compared with the group I, and the group II was compared at the point of time point. The difference was not statistically significant (P0.05). Compared with group I, the VAS score of group II decreased (P0.05).MMSE comparison in T1, T2, and T3 points after operation. Compared with group I, there was no significant difference in the MMSE score of group II at T0 time point (P0.05). Comparison of the level of beta amyloid protein (A beta) in blood: compared with group I, there was no significant difference in the level of p- amyloid protein (Ap) in the blood of group II at the time point of To (P0.05). Compared with group I, the level of p- amyloid egg white (A beta) in the blood of T1, T2, T3 at all time points was lower, and the difference was statistically significant (P0.05); the self controlled analgesic pump Comparison of the times of self pressing every 12 hours: compared with group I, group II had more pressing times per day, and the difference was statistically significant (P0.05). Conclusion flurbiprofen and sufentanil had good analgesic effect for postoperative analgesia in elderly patients. It was better than sufentanil alone for postoperative analgesia. Flurbiprofen was used in combination with Fentanil. Koshufinta Ni used for postoperative analgesia in the elderly patients to some extent reduce the incidence of adverse reactions, but also to a certain extent, it can significantly reduce the incidence of postoperative cognitive dysfunction.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 洪濤;聞大翔;杭燕南;;血清S100ββ變化與老年患者腹部手術(shù)后認(rèn)知功能障礙的關(guān)系[J];臨床麻醉學(xué)雜志;2006年08期

2 李偉;滕云鵬;薛榮亮;張瑛;;不完全性腦缺血后大鼠認(rèn)知功能的變化及其病理學(xué)機(jī)制的研究[J];山西醫(yī)科大學(xué)學(xué)報(bào);2012年05期

3 周汾;李肇端;余劍波;;術(shù)后認(rèn)知功能障礙病理生理研究新進(jìn)展[J];醫(yī)學(xué)綜述;2011年07期

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本文編號(hào)：1815073