本文選題：氫氣吸入 + 老年骨科患者　； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:術(shù)后認(rèn)知功能障礙(postoperative cognitive dysfunction,POCD)是麻醉和手術(shù)后出現(xiàn)的注意力不能集中、記憶能力下降等認(rèn)知功能改變,嚴(yán)重的患者還會出現(xiàn)人格和社會行為的能力下降,其臨床表現(xiàn)為認(rèn)知能力減退、焦慮、記憶缺損、語言理解能力和社會融合能力減退[1]。POCD不僅延長患者住院時(shí)間,增加住院費(fèi)用,而且增加患者術(shù)后病死率,引發(fā)了一系列醫(yī)學(xué)、社會及經(jīng)濟(jì)問題。POCD的病因及發(fā)病機(jī)制至今尚不明確,但越來越多的研究提示炎癥反應(yīng)可能在其中發(fā)揮了相當(dāng)重要作用[2,3]。氫氣是一種新型的氣體信號分子,具有多種作用,如:抗炎、抗氧化、抗凋亡、信號調(diào)節(jié),并對多種神經(jīng)系統(tǒng)疾病具有保護(hù)性作用[4,5]。本研究擬觀察氫氣吸入是否減少老年骨科患者POCD的發(fā)生及其可能機(jī)制,并為其預(yù)防和治療POCD提供理論依據(jù)。目的:探討氫氣吸入對骨科老年患者術(shù)后認(rèn)知功能障礙(POCD)的影響及其可能的機(jī)制。方法:擬在椎管內(nèi)麻醉下?lián)衿谛泄强剖中g(shù)患者54例,ASA分級Ⅱ或Ⅲ級,年齡≥75歲,采用隨機(jī)數(shù)字表法,將患者分為2組:對照組(C組)和氫氣吸入組(H組)。H組在麻醉前和手術(shù)結(jié)束后即刻分別給予含66.6%氫氣和33.3%氧氣的混合氣體吸入60min,C組給予33.3%氧氣吸入。于氫氣吸入前(H1)、吸入30min(H2)、吸入60min(H3)測定動脈血?dú)狻２捎煤喴字悄軤顟B(tài)檢查表(MMSE)評估術(shù)前無認(rèn)知功能障礙,并記錄術(shù)前一天(M1)、術(shù)后第一天(M2)、術(shù)后第三天(M3)、術(shù)后第七天(M4)的認(rèn)知功能評分,MMSE評分24分判定為POCD,記錄術(shù)后不同時(shí)間點(diǎn)POCD的發(fā)生率。于氣體吸入前(T1)、術(shù)后即刻(T2)、術(shù)后3h(T3)、術(shù)后6h(T4)采集動脈血樣,測定白介素-6(IL-6)和超氧化物歧化酶(SOD)水平。結(jié)果:兩組患者的一般情況各指標(biāo)、手術(shù)時(shí)間和出血量的比較無統(tǒng)計(jì)學(xué)差異(P0.05)。高濃度氫氣吸入不會影響患者的氧合功能,兩組比較無統(tǒng)計(jì)學(xué)意義(P0.05)。H組患者在M2、M3和M4時(shí)間點(diǎn)的POCD發(fā)生率分別為23.3%、10%和3.3%,均小于C組(33.3%,16.7%和8.3%),但兩組比較無統(tǒng)計(jì)學(xué)差異(P0.05)。與T1比較,T3、T4時(shí)兩組患者IL-6明顯升高,SOD活性明顯降低(P0.05);與C組比較,T2-T4時(shí)H組患者IL-6水平明顯減低,SOD活性明顯增高(P0.05)。結(jié)論:氫氣吸入可減少骨科老年患者術(shù)后認(rèn)知功能障礙的發(fā)生率,其機(jī)制可能與調(diào)控炎癥反應(yīng)和氧化應(yīng)激有關(guān)。
[Abstract]:Background: postoperative cognitive dysfunctional POCD is a kind of cognitive dysfunction after anaesthesia and surgery, such as the loss of attention, the decrease of memory, and the decrease of personality and social behavior in severe patients. The clinical manifestations of POCD were cognitive impairment, anxiety, memory impairment, language comprehension and social integration. POCD not only prolonged the hospitalization time and increased the cost of hospitalization, but also increased the postoperative mortality of patients, which led to a series of medicine. The etiology and pathogenesis of social and economic problems, POCD, are still unclear, but more and more studies suggest that inflammation may play a very important role in it. Hydrogen is a new type of gas signaling molecule, which has many functions, such as anti-inflammation, anti-oxidation, anti-apoptosis, signal regulation, and has protective effect on many nervous system diseases. The purpose of this study was to investigate whether hydrogen inhalation could reduce the incidence and possible mechanism of POCD in elderly orthopaedic patients, and to provide theoretical basis for the prevention and treatment of POCD. Objective: to investigate the effect of hydrogen inhalation on cognitive dysfunction (POCD) in elderly orthopaedic patients and its possible mechanism. Methods: 54 patients with ASA grade 鈪，

本文編號：1825405