长托宁对老年骨科全身麻醉患者术后认知功能障碍的影响

廖生根　李坤　张桂华

[摘要]目的 探讨长托宁对老年骨科全身麻醉患者术后认知功能障碍的影响。方法 选择我院2015年4月～2016年8月收治的144例拟行老年骨科全身麻醉患者，根据不同的治疗方式分为A组、B组、C组，每组48例。A组在术前30 min肌内注射长托宁1.0 mg，B组肌内注射阿托品0.5 mg，C组患者不采用任何术前用药。比较三组患者术前1 d和术后1、3 d的MMSE评分及POCD发生情况。结果 三组患者在术后1、3 d时的MMSE评分均低于本组术前1 d，差异有统计学意义（P<0.05）。A组术后1、3 d的MMSE评分均明显低于B组、C组，差异有统计学意义（P<0.05）。A组术后的POCD发生率明显低于B组、C组，差异有统计学意义（P<0.05）。结论 长托宁应用于老年骨科全身麻醉患者，易降低POCD发生率，并对患者术后认知功能产生相关影响，故应引起重视。

[关键词]长托宁；老年人；全身麻醉手术；认知功能障碍；影响

[中图分类号] R614.2 [文献标识码] A [文章编号] 1674-4721（2017）12（b）-0110-03

[Abstract]Objective To investigate the influence of Penehyclidine Hydrochloride on cognitive dysfunction in elderly patients after general anesthesia in department of orthopedics.Methods From April 2015 to August 2016，144 cases of elderly general anesthesia patients in department of orthopedics in our hospital were selected and divided into group A，group B，group C according to different treatment methods，each group had 48 cases.Group A received intramuscular injection of Penehyclidine Hydrochloride 1.0 mg at 30 min before operation，group B received intramuscular injection of Atropine 0.5 mg，group C were not treated with any prior medication.The MMSE score and the incidence rate of POCD at preoperative 1 day and postoperative 1 day，3 days were compared between the three groups.Results The MMSE scores of the three groups at preoperative 1 day were lower than that of at the postoperatively 1 day，3 days，and the difference was statistically significant （P<0.05）.The MMSE score of group A at postoperative 1 day，3 days were significantly lower than those in group B and group C，and the difference was statistically significant （P<0.05）.The incidence rate of POCD in group A was lower than that group B and group C，the difference was statistically significant （P<0.05）.Conclusion Penehyclidine Hydrochloride should be used for elderly patients with general anesthesia in department of orthopedics can reduce the incidence of patients with POCD，and which has a related influence on the postoperative cognitive function of the patients，it should be paid attention to.

[Key words]Penehyclidine hydrochloride；Elderly；General anesthesia；Cognitive dysfunction；Influence

老年人患者在手術后易出现认知功能障碍（postoperative cognitive dysfuction，POCD），尤其是骨科全身麻醉时会产生相应并发症，严重影响患者的术后治疗效果[1]。POCD属于一种中枢神经并发症，临床表现为记忆力减弱、精神紊乱和情绪焦虑和急躁等[2-3]，严重者易丧失语言能力和基本生活能力，直致死亡，因此应积极地采取有效措施来避免术后出现POCD症状。有研究显示，中枢特定区域的胆碱能通路参与老年患者POCD的发生[4]。长托宁属于抗胆碱类新药，在阻断外周胆碱能受体的同时，影响中枢胆碱能受体功能[5]。本研究旨在探讨长托宁对老年骨科全身麻醉患者POCD的影响，现报道如下。

1资料与方法endprint