【摘要】：目的:對(duì)中醫(yī)體質(zhì)學(xué)說(shuō)與老年患者POCD的相關(guān)性進(jìn)行研究,從中醫(yī)體質(zhì)特征上尋找規(guī)律,可能對(duì)老年患者POCD的辨證治療治則的指導(dǎo)有臨床意義。針對(duì)老年患者體質(zhì)類型與術(shù)后認(rèn)知功能狀況,探索影響認(rèn)知功能的影響因素,為圍術(shù)期的中西醫(yī)結(jié)合干預(yù)提供參考。方法:采用橫斷面臨床流行病學(xué)調(diào)查方法,收集我院60-90歲在氣管內(nèi)插管全麻下擬行下肢手術(shù)的患者。于術(shù)前一天完成中醫(yī)體重表和蒙特利爾認(rèn)知評(píng)估表(MoCA)首頁(yè)的填寫。術(shù)前記錄患者的住院號(hào)、性別、年齡、體重、文化程度、血壓、HR、既往病史、術(shù)前Hb與術(shù)前Hct,術(shù)后記錄患者的麻醉藥物用量、手術(shù)時(shí)間、麻醉時(shí)間、輸液量、出血量、尿量、手術(shù)類型、術(shù)后Hb、術(shù)后Hct、Hb差值、Hct差值。術(shù)后第三天再次完成蒙特利爾認(rèn)知評(píng)估表(MoCA)的填寫。完成病人基本資料的填寫并輸入計(jì)算機(jī)建立數(shù)據(jù)庫(kù),采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行描述性分析和推斷性分析(χ2檢驗(yàn)、t檢驗(yàn)、秩和檢驗(yàn)以及Logistic回歸分析)。結(jié)果:術(shù)后認(rèn)知功能障礙屬于輕度認(rèn)知損害,本次研究的老年患者發(fā)生POCD的人數(shù)為21人(12.7%),術(shù)后認(rèn)知功能較術(shù)前認(rèn)知功能發(fā)生認(rèn)知下降的患者有75人(45%)。166位老年患者的體質(zhì)類型分布為平和質(zhì)59例(35.5%)、瘀血質(zhì)30例(18.1%)、陽(yáng)虛質(zhì)30例(18.1%)、氣虛質(zhì)18例(10.8%)以及其它質(zhì)29例(17.5%)。發(fā)生認(rèn)知下降的患者的主要體質(zhì)類型為平和質(zhì)28(37.3%)、瘀血質(zhì)17(22.7%)、陽(yáng)虛質(zhì)10(13.3%)、氣虛質(zhì)10(13.3%)、其它質(zhì)10(13.3%)。不同性別在年齡、體重上存在統(tǒng)計(jì)學(xué)差異,有統(tǒng)計(jì)學(xué)意義(P0.05)。文化程度與年齡對(duì)術(shù)前認(rèn)知功能異常的發(fā)生存在統(tǒng)計(jì)學(xué)相關(guān)性,有統(tǒng)計(jì)學(xué)意義(P0.05)。文化程度與年齡對(duì)術(shù)后認(rèn)知功能異常的發(fā)生亦存在統(tǒng)計(jì)學(xué)相關(guān)性,有統(tǒng)計(jì)學(xué)意義(P0.05)。年齡、文化程度成為影響POCD發(fā)生的獨(dú)立危險(xiǎn)因素。手術(shù)類型與認(rèn)知下降的發(fā)生存在統(tǒng)計(jì)學(xué)相關(guān)性,有統(tǒng)計(jì)學(xué)意義(P0.05)。經(jīng)χ2檢驗(yàn),結(jié)果顯示術(shù)前認(rèn)知功能的評(píng)估結(jié)果與術(shù)后認(rèn)知功能的評(píng)估結(jié)果之間具有統(tǒng)計(jì)學(xué)意義(P0.001),麥克尼瑪爾檢驗(yàn)顯示兩者有統(tǒng)計(jì)學(xué)意義(P0.05),證明術(shù)前與術(shù)后這兩次認(rèn)知評(píng)估結(jié)果存在一致性,Kappa=0.667,說(shuō)明術(shù)前認(rèn)知能的評(píng)估結(jié)果與術(shù)后認(rèn)知功能的評(píng)估結(jié)果具有良好的一致性。瘀血質(zhì)與文化程度存在統(tǒng)計(jì)學(xué)相關(guān)性,有統(tǒng)計(jì)學(xué)意義(P0.05)。陽(yáng)虛質(zhì)患者的體重與非陽(yáng)虛質(zhì)患者的體重的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:本研究中的老年患者的體質(zhì)類型主要為平和質(zhì)、瘀血質(zhì)、陽(yáng)虛質(zhì)。發(fā)生認(rèn)知下降的老年患者的主要體質(zhì)類型為平和質(zhì)、瘀血質(zhì)、陽(yáng)虛質(zhì)以及氣虛質(zhì)。本研究的老年人的體質(zhì)以平和質(zhì)為主。術(shù)前認(rèn)知能的評(píng)估結(jié)果與術(shù)后認(rèn)知功能的評(píng)估結(jié)果具有良好的一致性。年齡與文化程度為影響POCD發(fā)生的獨(dú)立危險(xiǎn)因素。手術(shù)類型亦是影響認(rèn)知下降發(fā)生的獨(dú)立影響因素。本研究樣本量較少,且未行多中心研究。今后可施行大樣本的多中心研究,為中醫(yī)體質(zhì)與老年人早期術(shù)后認(rèn)知功能障礙的研究提供更充足的依據(jù)及更可靠的研究結(jié)果。
[Abstract]:Objective: To study the relationship between the Physique Theory of traditional Chinese medicine and the POCD of the elderly patients and to find the law from the physique of traditional Chinese medicine. It may be of clinical significance to the guidance of the treatment and treatment of POCD in the elderly patients. Medical combined intervention provided reference. Methods: the patients who were 60-90 years old under the tracheal intubation general anesthesia were collected by the method of cross-sectional epidemiological investigation. The patients were completed on the front page of the Chinese medicine body weight list and the Montreal cognitive assessment table (MoCA) one day before the operation. The hospital number, sex, age, weight, and weight were recorded before the operation. Degree, blood pressure, HR, past medical history, preoperative Hb and preoperative Hct, record the dosage of narcotic drugs, operation time, anesthesia time, infusion volume, bleeding volume, urine volume, operation type, postoperative Hb, postoperative Hct, Hb difference, Hct difference. Complete the completion of the Montreal cognitive assessment form (MoCA) again third days after the operation. Complete the basic information of the patients. Descriptive analysis and inferential analysis (x 2 test, t test, rank sum test and Logistic regression analysis) were used in SPSS17.0 statistical software for descriptive analysis and inference. Results: postoperative cognitive impairment was mild cognitive impairment, and the number of POCD in the elderly patients in this study was 21 (12.7%), and postoperative cognitive function was found. There were 75 (45%) patients with cognitive decline of cognitive function before operation (45%).166, 59 cases (35.5%), 30 cases (18.1%), 30 cases of Yang deficiency (18.1%), 18 (10.8%) and 29 (17.5%). The main physical types of cognitive decline were flat and qualitative 28 (37.3%), blood stasis. 7 (22.7%), Yang deficiency substance 10 (13.3%), Qi deficiency 10 (13.3%), other mass 10 (13.3%). There was statistical difference between age and body weight of different sex (P0.05). The degree of culture and age were statistically related to the occurrence of cognitive dysfunction before operation (P0.05). Cultural degree and age were different in cognitive function after operation. There was statistical correlation and statistical significance (P0.05). Age and educational level were independent risk factors affecting the occurrence of POCD. There was a statistically significant correlation between the type of operation and the occurrence of cognitive decline (P0.05). The results of the preoperative cognitive function evaluation and postoperative cognitive function were revealed by the chi square test. The results of the evaluation were statistically significant (P0.001). The McNemar test showed that the two were statistically significant (P0.05), demonstrating the consistency between the two cognitive assessment results before and after the operation, and Kappa=0.667. The results showed that the evaluation results of cognitive ability before operation were in good agreement with the results of postoperative cognitive ability assessment. There was statistical significance (P0.05). The body weight of patients with Yang deficiency and non Yang deficiency was statistically significant (P0.05). Conclusion: the physical types of the elderly patients in this study were mainly flat, blood stasis and yang deficiency. The main physical types of elderly patients with cognitive decline were flat and flat. Quality, ecchymosis, Yang deficiency and Qi deficiency. The physique of the elderly in this study was mainly flat and qualitative. The assessment results of pre operation cognitive ability were in good agreement with the evaluation results of postoperative cognitive function. Age and educational level were independent risk factors affecting the occurrence of POCD. The surgical type also influenced the independent influence of cognitive decline. In the future, a multi center study of large samples can be carried out to provide more sufficient basis and more reliable research results for the study of Chinese Medical Constitution and the early postoperative cognitive impairment of the elderly.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R619

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