术前应用盐酸戊乙奎醚对老年胸、腹手术患者术后早期认知功能的影响

Effects of preoperative application of penehyclidine hydrochloride on early cognitive function in elderly patients after thoracic and abdominal surgery

目的:探讨盐酸戊乙奎醚用于老年人胸、腹手术全身麻醉前对其术后早期认知功能的影响。方法:选取我院胸、腹手术全身麻醉老年患者120例,随机分为A组和B组各60例。其中A组在麻醉诱导前30 min肌肉注射盐酸戊乙奎醚0. 5 mg,B组注射等量生理盐水。监测并记录两组术前、麻醉诱导后、术中10 min、术毕平均动脉压(MAP)、心率(HR);两组术前24 h,术后24 h、48 h、72 h采用简易智力状态检查法(MMSE)评估认知功能情况,并记录术后认知功能障碍(POCD)例数,取两组各时段动脉血测其血清中S100β蛋白含量情况。结果:两组术前、术中、术后各项指标监测情况均在正常值范围,其中A组各个时段平均动脉压(MAP)、心率(HR)差异均无统计学意义(P> 0. 05),B组术中10 min、术毕平均动脉压(MAP)、心率(HR)均低于手术前和麻醉诱导后,差异有统计学意义(P <0. 05); A组MMES评分术后各时段波动范围较B组小,差异有统计学意义(P <0. 016 7),其中A组术后POCD有4例(6. 67%),明显低于B组18例(30. 00%),差异有统计学意义(P <0. 05);术后24 h、48 h、72 h,A组S100β蛋白含量均低于B组,差异有统计学意义(P <0. 05)。结论:老年人胸、腹手术前应用盐酸戊乙奎醚能有效降低患者术后早期认知功能障碍发生率。

Objective ： To explore the effects of penehyclidine hydrochloride on early cognitive function in the general anesthesia of elderly patients undergoing thoracic and abdominal surgery. Methods： A total of 120 elderly patients with general anesthesia of thoracic and abdominal surgery were selected and randomly divided into group A and group B, with 60 cases in each group. Group A was intramuscularly injected 0.5 mg penehyclidine hydrochloride at 30 rain before anesthesia induction, and group B was injected with the same amount of normal saline. The mean arterial pressure （MAP） and heart rate （HR） were monitored and recorded before operation, after anesthesia induction, at 10 rain during operation and at the end of operation. The Mini-Mental State Examination （MMSE） was used to evaluate the cognitive function at 24 h before operation and at 24 h, 48 h and 72 h after operation. The number of cases with postoperative cognitive dysfunction （POCD） was recorded. The serum level of S100β protein was measured by arterial blood in each group. Results： The preoperative, intraoperative and postoperative indexes in the two groups were in the normal range, and there were no significant differences in mean arterial pressure （MAP） and heart rate （HR） in group A at each time point （P 〉 0.05）, and the mean arterial pressure （MAP） and heart rate （HR） in group B at 10min during operation and at the end of operation were lower than those before operation and after anesthesia induction （ P 〈 0.05 ）. The postoperative fluctuation range of MMES score in group A was smaller than that in group B （ P 〈 0. 016 7 ） , and the number of cases withPOCD in group A was significantly lower than that in group B 4 cases （6.67%） vs 18 eases （30.00%） （P 〈0.05）. At 24h, 48h and 72h after operation, the level of S1000β protein in group A was lower than that in group B （ P 〈 0.05 ）. Conclusions： Preoperative application of penehyelidine hydroehloride before thoracic and abdominal surgery in elderly patients can effectively reduce the incidence rate of early postoperative cognitive dysfunction.