摘要
目的比较老年肺癌患者术中轻度低温及正常体温条件下术后早期认知功能的变化,探讨轻度低温对老年患者术后早期认知功能障碍的影响.方法 ASAⅠ或Ⅱ级拟行肺癌手术老年患者40例,年龄65～83岁,随机均分为常温组(Ⅰ组)和轻度低温组(Ⅱ组).分别于术前1 d(N)1、术后1 d(N)2及术后3 d(N)3用MMSE量表对患者进行神经精神功能测试.结果与N1时比较,N2时2组患者MMSE评分均下降(P<0.05),尤以Ⅱ组降低明显,组间比较差异有统计学意义(P<0.05),N3时评分又升高,与N2比较差异有统计学意义(P<0.05);N2时Ⅱ组患者术后认知功能障碍(POCD)发生率明显高于Ⅰ组,但组间差异无统计学意义(P>0.05).结论术中轻度低温可促进老年肺癌患者术后早期认知功能能障产生,而术中采取保温措施,维持正常体温,对降低老年患者术后早期认知功能障碍发生,具有一定的保护作用.
Objective To investigate the effects of mild hypothermia undergoing surgery on early postoperative cognitive dysfunction （POCD） in elderly patients with lung cancer. Methods Forty ASA classification I or II patients with lung cancer （aged 65-83yr） undergoing surgery were randomly divided into 2 groups （n = 20） ： normal body temperature group （Group I ） and mild hypothermia group （Group II ） Anesthesia was induced with midazolam, fentanyl, etomidate and vecuronium and maintained with propofol, refentanil and vecuronium. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 35-45 mm Hg. The cognitive function test （MMSE） were performed at one day before operation （N,）, one day after operation （N2） and the third day after operation （N3） . Results Compared with N1, the score of both groups were decreased at N2 （P 〈 0.05） , and it was lower in Group II than that in Group I （P 〈 0.05） . There was significant difference between the two groups. The score of both groups were increased significantly at N3 （P 〈 0.05） , and there was significant difference with N2 （P 〈 0.05） . Early POCD occurred in 5 patients （25%） in the Group II and in 3 patients （15%） in the Group I , there was no significant difference between in two groups at N2 （P 〈 0.05） . Conclusion Mild hypothermia undergoing surgery can promote early POCD in elderly patients with lung cancer. Normothermia can reduce certain early POCD in elderly, but it cannot decrease the general incidence of early POCD.
出处
《昆明医科大学学报》
CAS
2013年第5期123-127,共5页
Journal of Kunming Medical University
