围手术期心理支持疗法对老年结核病患者术后认知功能障碍的影响

Impact of perioperative psychological supportive therapy on postoperative cognitive dysfunction in elderly patients with tuberculosis

目的探讨围手术期心理支持(perioperative psychological support therapy,PPST)对老年结核病患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的影响。方法采用病例-对照研究方法,2008年7月至2009年5月本院老年结核病手术患者实施常规护理为对照组,2009年6月至2010年7月本院老年结核病手术患者在常规护理基础上实施PPST为研究组,应用神经心理学测验的简易智能状态检查表(MMSE),中国韦氏成人智力量表(WAIC-RC)的连线测验、数字符号和数字广度,焦虑自评量表(self-rating anxiety scale,SAS)对两组进行测试;对照组93例,研究组91例。结果研究组各项神经心理学测验:术后7 d连线测验A对照组得分49.96±10.43,研究组44.02±17.29,t=2.942,P<0.05;连线测试B对照组得分67.99±17.72,研究组60.37±18.88,t=2.971,P<0.05;数字符号对照组得分24.44±8.31,研究组28.76±8.76,t=3.578,P<0.01;简易智能状态检测对照组得分26.47±2.07,研究组27.62±2.73,t=3.359,P<0.05;焦虑自评量表对照组得分35.33±7.12,研究组30.51±5.10,t=5.502,P<0.01。术后1个月连线测验A对照组得分44.49±10.89,研究组得分37.61±13.49,t=3.968,P<0.01;连线测试B对照组得分61.64±15.35,研究组得分54.00±16.49,t=3.392,P<0.05;数字符号对照组得分27.38±7.81,研究组得分32.58±8.17,t=4.602,P<0.01;数字广度对照组得分7.71±1.33,研究组得分8.81±1.36,t=5.785,P<0.01;简易智能状态检测对照组得分27.63±1.69,研究组得分28.67±2.17,t=3.785,P<0.01;焦虑自评量表得分,对照组31.13±7.09,研究组27.30±3.53,t=4.836,P<0.01。结论围手术期心理支持可以有效地降低手术对患者神经心理的不良刺激,减低焦虑水平。

Objective To explore the impact of perioperative psychological support therapy on postoperative cognitive dysfunction in elderly patients with tuberculosis.Methods A case-control study was conducted.The elderly patients with tuberculosis who had undergone surgery during the period of July 2008 to May 2009（93 patients,control group） and of June 2009 to July 2010（91 patients,study group） were assessed by using the Mini-Mental State Examination（MMSE）,Trail Making Test（TMT） Parts A B,Digit Symbol Substitution Test（DSST）,and Digit Span Test（DST） in Wechsler Adult Intelligence Scale-Revised by China（WAIS-RC）,and Self-Rating Anxiety Scale（SAS）.Results Seven days after surgery,the scores on TMT A were 49.96±10.43 in the control group and 44.02±17.29 in the study group（t=2.942,P0.05）,and those on TMT B were 67.99±17.72 and 60.37±18.88,respectively（t=2.971,P0.05）;the scores on DSST was 24.44±8.31 in the control group and 28.76±8.76 in the study group（t=3.578,P0.01）;the scores on MMSE was 26.47±2.07 in the control group and 27.62±2.73 in the study group（t=3.359,P0.05）;the scores on SAS was 35.33±7.12 in the control group and 30.51±5.10 in the study group（t=5.502,P0.01）.One month after surgery,the scores on TMT A were 44.49±10.89 in the control group and 37.61±13.49 in the study group（t=3.968,P0.01）,and those on TMT B were 61.64±15.35 and 54.00±16.49,respectively（t=3.392,P0.05）;the scores on DSST were 27.38±7.81 in the control group and 32.58±8.17 in the study group（t=4.602,P0.01）;the scores on DST were 7.71±1.33 in the control group and 8.81±1.36 in the study group（t=5.785,P0.01）;the scores on MMSE were 27.63±1.69 in the control group and 28.67±2.17 in the study group（t=3.785,P0.01）;the scores on SAS were 31.13±7.09 in the control group and 27.30±3.53 in the study group（t=4.836,P0.01）.Conclusion Perioperative psychological support therapy can effectively reduce the adverse effects of surgery on patients psychology and lower the degree of anxiety.