To the Editor:In a randomized controlled preliminary trial comparing effects of propofol,dexmedetomidine,and midazolam on postoperative cognitive dysfunction(POCD)in elderly patients undergoing hip or knee arthroplast...To the Editor:In a randomized controlled preliminary trial comparing effects of propofol,dexmedetomidine,and midazolam on postoperative cognitive dysfunction(POCD)in elderly patients undergoing hip or knee arthroplasty with combined spinal-epidural anesthesia,Li et al[1]showed that intraoperative sedation with propofol compared to dexmedetomidine can significantly decrease risk of POCD.Given that POCD is associated with major adverse consequences,for example,an increased mortality rate,reduced quality of life,and delayed long-term recovery,[2]their findings have potential implications.However,we note that this finding is totally different from the results of a recent large randomized controlled study in elderly patients undergoing hip arthroplasty with the peripheral nerve block,in which patients sedated with dexmedetomidine have a lower risk of POCD than those sedated with propofol.展开更多
目的观察老年下肢手术患者围手术期血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、S-100β变化,探讨术后认知功能障碍的(postoperative cognitive dysfunction,POCD)发生与NSE、S-100β变化的关系。方法择期行下肢手术的老...目的观察老年下肢手术患者围手术期血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、S-100β变化,探讨术后认知功能障碍的(postoperative cognitive dysfunction,POCD)发生与NSE、S-100β变化的关系。方法择期行下肢手术的老年患者86例,分别于术前24h、术后6h以及48h进行老年认知功能量表(the scale of elderly congitive fuction,SECF)测定;同时检测术前24h、术后6h以及48h血清中NSE、S-100β蛋白水平。结果①术后共有21例患者被诊断为POCD。②NSE水平在术后6h以及48h均明显升高,与术前24h相比差异有显著统计学意义;③S-100β仅在术后6h显著升高,与术前24h相比差异有显著统计学意义;术后48h下降至术前水平。④发生POCD的患者,其术后NSE以及S-100β蛋白水平明显高于未发生者。结论老年患者术后NSE、S-100β蛋白水平明显升高,血清中NSE、S-100β蛋白水平的变化与POCD的发生有密切关系。展开更多
目的采用循证医学的方法系统评价右美托咪定在老年患者全麻术后认知功能障碍的影响。方法计算机检索Cochrane、Pub Med、Medline、知网、维普、万方数据库,均从建库到2015年7月发表的文献,对符合纳入与排除标准的研究进行资料提取,并采...目的采用循证医学的方法系统评价右美托咪定在老年患者全麻术后认知功能障碍的影响。方法计算机检索Cochrane、Pub Med、Medline、知网、维普、万方数据库,均从建库到2015年7月发表的文献,对符合纳入与排除标准的研究进行资料提取,并采用Rev Man 5.2软件进行Meta分析。结果最终纳入13个随机对照试验,共计854例患者。Meta分析结果显示:术后1 d右美托咪定组简易精神状态评价量表(MMSE评分)高于对照组,差异有统计学意义(P<0.05);右美托咪定组术后1 d POCD的发生率明显低于对照组(P<0.05),差异有统计学意义。结论老年患者全麻术中使用右美托咪定,能有效改善患者术后认知功能障碍,降低POCD的发生率。展开更多
文摘To the Editor:In a randomized controlled preliminary trial comparing effects of propofol,dexmedetomidine,and midazolam on postoperative cognitive dysfunction(POCD)in elderly patients undergoing hip or knee arthroplasty with combined spinal-epidural anesthesia,Li et al[1]showed that intraoperative sedation with propofol compared to dexmedetomidine can significantly decrease risk of POCD.Given that POCD is associated with major adverse consequences,for example,an increased mortality rate,reduced quality of life,and delayed long-term recovery,[2]their findings have potential implications.However,we note that this finding is totally different from the results of a recent large randomized controlled study in elderly patients undergoing hip arthroplasty with the peripheral nerve block,in which patients sedated with dexmedetomidine have a lower risk of POCD than those sedated with propofol.
文摘目的观察老年下肢手术患者围手术期血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、S-100β变化,探讨术后认知功能障碍的(postoperative cognitive dysfunction,POCD)发生与NSE、S-100β变化的关系。方法择期行下肢手术的老年患者86例,分别于术前24h、术后6h以及48h进行老年认知功能量表(the scale of elderly congitive fuction,SECF)测定;同时检测术前24h、术后6h以及48h血清中NSE、S-100β蛋白水平。结果①术后共有21例患者被诊断为POCD。②NSE水平在术后6h以及48h均明显升高,与术前24h相比差异有显著统计学意义;③S-100β仅在术后6h显著升高,与术前24h相比差异有显著统计学意义;术后48h下降至术前水平。④发生POCD的患者,其术后NSE以及S-100β蛋白水平明显高于未发生者。结论老年患者术后NSE、S-100β蛋白水平明显升高,血清中NSE、S-100β蛋白水平的变化与POCD的发生有密切关系。
文摘目的采用循证医学的方法系统评价右美托咪定在老年患者全麻术后认知功能障碍的影响。方法计算机检索Cochrane、Pub Med、Medline、知网、维普、万方数据库,均从建库到2015年7月发表的文献,对符合纳入与排除标准的研究进行资料提取,并采用Rev Man 5.2软件进行Meta分析。结果最终纳入13个随机对照试验,共计854例患者。Meta分析结果显示:术后1 d右美托咪定组简易精神状态评价量表(MMSE评分)高于对照组,差异有统计学意义(P<0.05);右美托咪定组术后1 d POCD的发生率明显低于对照组(P<0.05),差异有统计学意义。结论老年患者全麻术中使用右美托咪定,能有效改善患者术后认知功能障碍,降低POCD的发生率。
