本文關(guān)鍵詞： 頭針 老年患者 髖關(guān)節(jié)置換術(shù) 認(rèn)知障礙 神經(jīng)元特異性烯醇化酶 S-β蛋白　出處：《中國(guó)中西醫(yī)結(jié)合雜志》2016年06期 　論文類型：期刊論文

【摘要】：目的探討頭針對(duì)老年髖關(guān)節(jié)置換術(shù)患者血清神經(jīng)元特異性烯醇化酶(neuron specific enolase,NSE)、S-100β蛋白濃度與術(shù)后譫妄(postoperative delirium,POD)、術(shù)后認(rèn)知功能障礙(postoperative cognitive dysfunction,POCD)發(fā)生率的影響。方法將84例擇期腰麻與硬膜外聯(lián)合阻滯麻醉下行髖關(guān)節(jié)置換術(shù)的老年患者按隨機(jī)數(shù)字表法分為對(duì)照組、治療組,每組42例。治療組根據(jù)國(guó)際頭針穴名標(biāo)準(zhǔn)化方案,取MS1額中線(從神庭向前1寸,包括神庭穴)、MS5頂中線(百會(huì)至前頂,包括百會(huì)及前頂穴),于術(shù)中行頭針治療。觀察兩組手術(shù)時(shí)間及術(shù)后住院時(shí)間,術(shù)中咪達(dá)唑侖用量、出血量、輸液量、尿量、麻黃堿及阿托品使用率,POD發(fā)生率與術(shù)后3天(T_1)、1周(T_2)、3個(gè)月(T_3)及6個(gè)月(T_4)患者POCD發(fā)生率;兩組各隨機(jī)選擇18例患者于麻醉前(t0)、術(shù)畢(t1)、術(shù)后6 h(t_2)、24 h(t_3)及48 h(t_4)頸內(nèi)靜脈采血,檢測(cè)血清NSE、S-100β蛋白濃度。結(jié)果兩組手術(shù)時(shí)間、術(shù)中咪達(dá)唑侖用量、出血量、輸液量、尿量、麻黃堿及阿托品使用率比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。與對(duì)照組比較,治療組術(shù)后住院時(shí)縮短(P0.05),治療組POD及術(shù)后各時(shí)間點(diǎn)POCD發(fā)生率降低(P0.05),治療組t_2~t_4NSE蛋白表達(dá)降低(P0.05),t1~t4S-100β蛋白表達(dá)降低(P0.05),其他時(shí)間點(diǎn)兩組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論頭針可減輕老年患者中樞神經(jīng)系統(tǒng)損傷,改善術(shù)后認(rèn)知功能。
[Abstract]:Objective to investigate the serum neuron specific enolase (specific) in elderly patients undergoing hip arthroplasty. S-100 尾 protein concentration and postoperative delirium delirium (POD). Postoperative cognitive dysfunction. Methods Eighty-four elderly patients undergoing hip arthroplasty under combined spinal and epidural anesthesia were randomly divided into control group and treatment group. 42 cases in each group. According to the international standard scheme of scalp acupuncture point name, the treatment group took the midline of MS1 forehead (1 inch forward from Shenting, including the midline of MS5 at Shenting point) (Baihui to anterior top, including Baihui and Qianding points). The operation time and postoperative hospitalization time, midazolam dosage, blood loss, transfusion volume, urine volume, ephedrine and atropine usage were observed. The incidence of POD and the incidence of POCD in patients with T _ (2), T _ (3) and T _ (4) at 3 days after operation were significantly higher than those in patients with T _ (2) and T _ (T _ (4)) at 3 days after operation. 18 patients in each group were randomly selected to collect blood from internal jugular vein before anesthesia, after operation, after operation, 6 hours after operation, 24 hours after operation, 24 hours after operation, 24 hours after operation, and 48 hours after operation. Results the operation time, intraoperative midazolam dosage, blood loss, transfusion volume, urine volume, ephedrine and atropine utilization rate were compared between the two groups. The difference was not statistically significant (P 0.05). Compared with the control group, the treatment group shortened the hospitalization time after operation (P 0.05). In the treatment group, the incidence of POD and POCD at different time points after operation was decreased (P 0.05), and the expression of t 2 and t 4 NSE protein in the treatment group was decreased (P 0.05). The expression of t4S-100 尾 protein decreased in the two groups, but there was no significant difference between the two groups at other time points. Conclusion scalp acupuncture can alleviate the injury of central nervous system in elderly patients. To improve postoperative cognitive function.
【作者單位】： 青島市海慈醫(yī)療集團(tuán)麻醉科;青島市海慈醫(yī)療集團(tuán)藥劑科;青島市海慈醫(yī)療集團(tuán)神經(jīng)內(nèi)科;青島市市立醫(yī)院麻醉科;
【基金】：青島市市南區(qū)科技局資助項(xiàng)目(No.2014-14-032-yy)
【分類號(hào)】：R614
【正文快照】： 老年患者術(shù)后譫妄(postoperative delirium,POD)及認(rèn)知功能障礙(postoperative cognitive dysfunction,POCD)發(fā)生率較高。部分POCD患者可發(fā)展為永久性POCD或癡呆,嚴(yán)重影響患者的生活質(zhì)量并增加遠(yuǎn)期并發(fā)癥的發(fā)生率和病死率,造成沉重的家庭及社會(huì)負(fù)擔(dān)。研究顯示頭針對(duì)血管性及腦

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