预防老年髋关节手术患者术后认知功能障碍的麻醉相关措施研究进展
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摘要
术后认知功能障碍(POCD)是老年患者术后不可忽视的并发症之一,从临床角度出发寻求相应保护措施,是加快患者术后恢复及提高其术后生存质量的关键步骤。针对髋关节手术患者,右美托咪定和乌司他丁可通过抑制中枢炎症反应降低患者POCD的发生率;同时,神经阻滞及经皮穴位电刺激还可通过缓解患者围术期的疼痛、加快术后的恢复,降低患者术后认知水平的下降程度;而脑电图监测下麻醉深度的管理对患者术后认知功能的影响,未来需进一步研究。
Postoperative cognitive dysfunction( POCD) is one of the complications that cannot be neglected after operation in elderly patients. Seeking corresponding clinical protective measures is the key step to accelerate the recovery and improve the quality of life of the patients after operation. According to the reports,dexmedetomidine and ulinastatin can reduce the incidence of POCD by inhibiting central inflammation in patients undergoing hip joint surgery,while nerve block and transcutaneous electrical acupoint stimulation can also alleviate perioperative pain,accelerate postoperative recovery and reduce the decline of postoperative cognitive level. However,the effect of anesthesia depth management under electroencephalogram monitoring on postoperative cognitive function of the patients still needs further study in the future.
Postoperative cognitive dysfunction( POCD) is one of the complications that cannot be neglected after operation in elderly patients. Seeking corresponding clinical protective measures is the key step to accelerate the recovery and improve the quality of life of the patients after operation. According to the reports,dexmedetomidine and ulinastatin can reduce the incidence of POCD by inhibiting central inflammation in patients undergoing hip joint surgery,while nerve block and transcutaneous electrical acupoint stimulation can also alleviate perioperative pain,accelerate postoperative recovery and reduce the decline of postoperative cognitive level. However,the effect of anesthesia depth management under electroencephalogram monitoring on postoperative cognitive function of the patients still needs further study in the future.
引文
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[31]Mei B,Zha H,Lu X,et al.Peripheral nerve block as a supplement to light or deep general anesthesia in elderly patients receiving total hip arthroplasty:A prospective randomized study[J].Clin JPain,2017,33(12):1053-1059.
[32]Odor PM,Chis SI,Wilkinson I,et al.Effect of admission fascia iliaca compartment blocks on post-operative abbreviated mental test scores in elderly fractured neck of femur patients:A retrospective cohort study[J].BMC Anesthesiol,2017,17(1):2.
[33]高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[34]邵晓梅,方剑乔,周传龙,等.经皮穴位电刺激复合药物全麻行控制性降压对丘脑局部血流的影响[J].临床麻醉学杂志,2012,28(6):599-601.
[35]王均炉,任秋生,裴圣林.经皮穴位电刺激对颅脑围手术期脑氧及糖代谢的影响[J].中国中西医结合杂志,2008,28(3):201-205.
[36]林舜艳,尹正录,高巨,等.针刺麻醉对老年患者肠癌切除术后认知功能障碍影响及其S-100β蛋白的变化[J].中国针灸,2013,33(1):63-66.
[37]郭波,谢亮,邓田,等.电针对老年全麻手术患者术后早期认知功能障碍的影响[J].中国中医急症,2017,26(6):1083-1086.
[38]刘佩蓉,彭生,韩振祥,等.电针“四关”穴对老年患者髋关节置换术后认知功能的影响[J].同济大学学报(医学版),2017,38(6):67-71.
[39]姜慧丽,陈利海,王丹丹,等.电针预处理对于老年关节置换术后认知功能障碍的影响[J].上海医学,2014,37(12):1017-1019.
[40]Chan MT,Cheng BC,Lee TM,et al.BIS-guided anesthesia decreases postoperative delirium and cognitive decline[J].J Neurosurg Anesthesiol,2013,25(1):33-42.
[41]Aldecoa C,Bettelli G,Bilotta F,et al.European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium[J].Eur J Anaesthesiol,2017,34(4):192-214.
[42]Devinney MJ,Mathew JP,Berger M.Postoperative delirium and postoperative cognitive dysfunction:Two sides of the same coin[J].Anesthesiology,2018,129(3):389-391.
[43]Leblanc D,ContéM,Masson G,et al.SmartPilotview-guided anaesthesia improves postoperative outcomes in hip fracture surgery:A randomized blinded controlled study[J].Br JAnaesth,2017,119(5):1022-1029.
[44]Walsh M,Devereaux PJ,Garg AX,et al.Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery:Toward an empirical definition of hypotension[J].Anesthesiology,2013,119(3):507-515.
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[46]Kertai MD,Whitlock EL,Avidan MS.Brain monitoring with electroencephalography and the electroencephalogram-derived bispectral index during cardiac surgery[J].Anesth Analg,2012,114(3):533-546.
[47]Giattino CM,Gardner JE,Sbahi FM,et al.Intraoperative frontal alpha-band power correlates with preoperative neurocognitive function in older adults[J].Front Syst Neurosci,2017,11:24.
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[2]Bedford PD.Adverse cerebral effects of anaesthesia on old people[J].Lancet,1955,269(6884):259-263.
[3]Beishuizen SJE,van Munster BC,de Jonghe A,et al.Distinct cognitive trajectories in the first year after hip fracture[J].J Am Geriatr Soc,2017,65(5):1034-1042.
[4]Moller JT,Cluitmans P,Rasmussen LS,et al.Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study.ISPOCDinvestigators.International study of post-operative cognitive dysfunction[J].Lancet,1998,351(9106):857-861.
[5]唐玉洁,欧阳文.术后认知功能障碍炎症相关机制及其防治[J].中南大学学报(医学版),2017,42(11):1321-1326.
[6]Zheng YB,Ruan GM,Fu JX,et al.Postoperative plasma 8-isoprostaglandin F2αlevels are associated with delirium and cognitive dysfunction in elderly patients after hip fracture surgery[J].Clin Chim Acta,2016,455:149-153.
[7]An LN,Yue Y,Guo WZ,et al.Surgical trauma induces iron accumulation and oxidative stress in a rodent model of postoperative cognitive dysfunction[J].Biol Trace Elem Res,2013,151(2):277-283.
[8]金鑫,金超,周艳瑾.右美托咪定对老年患者髋关节置换术后认知功能障碍及围术期T淋巴细胞亚群的影响[J].中国药房,2016,27(2):242-245.
[9]Zhou C,Zhu Y,Liu Z,et al.Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia:A meta-analysis[J].J Int Med Res,2016,44(6):1182-1190.
[10]曾德亮,章放香,马熠,等.右美托咪定复合罗哌卡因连续腰丛神经阻滞对髋关节置换术后早期康复的影响[J].临床麻醉学杂志,2016,32(12):1165-1168.
[11]李丽,辛险峰,陈冰.右美托咪定对老年髋关节手术术后POCD发生率、S-100β蛋白水平的影响[J].齐齐哈尔医学院学报,2017,38(24):2881-882.
[12]黄金平,张兴安,李丽妍.右美托咪定预输注对老年髋关节置换患者全麻术后认知功能的影响[J].广州医学院学报,2016,44(2):49-54.
[13]Mei B,Meng G,Xu G,et al.Intraoperative sedation with dexmedetomidine is superior to propofol for elderly patients undergoing hip arthroplasty:A prospective randomized controlled study[J].Clin J Pain,2018,34(9):811-817.
[14]施丽燕,徐静,万燕杰,等.术后认知功能障碍与α1-抗糜蛋白酶表达的临床研究[J].临床麻醉学杂志,2014,30(7):637-640.
[15]Lv ZT,Huang JM,Zhang JM,et al.Effect of ulinastatin in the treatment of postperative cognitive dysfunction:Review of current literature[J].Biomed Res Int,2016,2016:2571080.
[16]康亚梅.乌司他丁对老年髋关节置换患者术后认知功能障碍的影响[J].中国骨伤,2010,23(5):355-357.
[17]单新,张秀宁,李雪靖,等.乌司他丁预处理对老年髋部骨折患者术后认知功能的影响[J].中华医学杂志,2015,95(20):1586-1589.
[18]Koga Y,Fujita M,Tsuruta R,et al.Urinary trypsin inhibitor suppresses excessive superoxide anion radical generation in blood,oxidative stress,early inflammation,and endothelial injury in forebrain ischemia/reperfusion rats[J].Neurol Res,2010,32(9):925-932.
[19]Aasvang EK,Luna IE,Kehlet H.Challenges in postdischarge function and recovery:The case of fast-track hip and knee arthroplasty[J].Br J Anaesth,2015,115(6):861-866.
[20]Lu G,Zhou QX,Kang S,et al.Chronic morphine treatment impaired hippocampal long-term potentiation and spatial memory via accumulation of extracellular adenosine acting on adenosine A1 receptors[J].J Neurosci,2010,30(14):5058-5070.
[21]陈思涵,Lim YW,闻大翔,等.术前慢性疼痛对大鼠术后认知功能下降的易化作用和对中缝背核区色氨酸羟化酶的影响[J].上海医学,2016,39(6):368-373,388.
[22]郑羡河,蒋宗明,张昌锋,等.帕瑞昔布钠超前镇痛对老年病人术后认知功能的影响[J].中华麻醉学杂志,2011,31(3):310-312.
[23]李井柱,李晓征,王晓敏,等.帕瑞昔布钠镇痛对老年急诊股骨头置换术患者神经系统的影响[J].中华医学杂志,2013,93(27):2152-2154.
[24]Tian Y,Zhao P,Li L,et al.Pre-emptive parecoxib and post-operative cognitive function in elderly patients[J].Int Psychogeriatr,2014,15:1-8.
[25]马怀宾.帕瑞昔布钠对老年髋部术后炎症反应及认知功能的影响[J].中国乡村医药,2015,22(17):27-28.
[26]赵璞,何龙,李志松,等.帕瑞昔布钠对老年膝关节置换术患者术后早期认知功能的影响[J].中国老年学,2012,32(19):4115-4117.
[27]魏福生,李秀泽,李娟,等.不同剂量右美托咪定复合帕瑞昔布钠对老年患者术后早期认知功能的影响[J].实用医药杂志,2016,33(6):502-504.
[28]黄松,华福洲,张静.乌司他丁复合帕瑞昔布钠对老年患者髋关节置换术后早期细胞免疫及认知功能的影响[J].临床麻醉学杂志,2017,33(4):321-325.
[29]Karaca S,Ayhan E,Kesmezacar H,et al.Hip fracture mortality:Is it affected by anesthesia techniques?[J].Anesthesiol Res Pract,2012,2012:708754.
[30]陆小龙,梅斌,陈士寿.超声引导下腰骶丛神经阻滞联合全麻在高龄患者髋关节置换术的临床应用[J].临床麻醉学杂志,2016,32(3):237-240.
[31]Mei B,Zha H,Lu X,et al.Peripheral nerve block as a supplement to light or deep general anesthesia in elderly patients receiving total hip arthroplasty:A prospective randomized study[J].Clin JPain,2017,33(12):1053-1059.
[32]Odor PM,Chis SI,Wilkinson I,et al.Effect of admission fascia iliaca compartment blocks on post-operative abbreviated mental test scores in elderly fractured neck of femur patients:A retrospective cohort study[J].BMC Anesthesiol,2017,17(1):2.
[33]高军龙,李玉兰.浅谈经皮穴位电刺激在围麻醉期的多种作用[J].中国针灸,2015,35(3):269-273.
[34]邵晓梅,方剑乔,周传龙,等.经皮穴位电刺激复合药物全麻行控制性降压对丘脑局部血流的影响[J].临床麻醉学杂志,2012,28(6):599-601.
[35]王均炉,任秋生,裴圣林.经皮穴位电刺激对颅脑围手术期脑氧及糖代谢的影响[J].中国中西医结合杂志,2008,28(3):201-205.
[36]林舜艳,尹正录,高巨,等.针刺麻醉对老年患者肠癌切除术后认知功能障碍影响及其S-100β蛋白的变化[J].中国针灸,2013,33(1):63-66.
[37]郭波,谢亮,邓田,等.电针对老年全麻手术患者术后早期认知功能障碍的影响[J].中国中医急症,2017,26(6):1083-1086.
[38]刘佩蓉,彭生,韩振祥,等.电针“四关”穴对老年患者髋关节置换术后认知功能的影响[J].同济大学学报(医学版),2017,38(6):67-71.
[39]姜慧丽,陈利海,王丹丹,等.电针预处理对于老年关节置换术后认知功能障碍的影响[J].上海医学,2014,37(12):1017-1019.
[40]Chan MT,Cheng BC,Lee TM,et al.BIS-guided anesthesia decreases postoperative delirium and cognitive decline[J].J Neurosurg Anesthesiol,2013,25(1):33-42.
[41]Aldecoa C,Bettelli G,Bilotta F,et al.European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium[J].Eur J Anaesthesiol,2017,34(4):192-214.
[42]Devinney MJ,Mathew JP,Berger M.Postoperative delirium and postoperative cognitive dysfunction:Two sides of the same coin[J].Anesthesiology,2018,129(3):389-391.
[43]Leblanc D,ContéM,Masson G,et al.SmartPilotview-guided anaesthesia improves postoperative outcomes in hip fracture surgery:A randomized blinded controlled study[J].Br JAnaesth,2017,119(5):1022-1029.
[44]Walsh M,Devereaux PJ,Garg AX,et al.Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery:Toward an empirical definition of hypotension[J].Anesthesiology,2013,119(3):507-515.
[45]谢莉,柴小青.术中低血压与血压波动对老年患者术后认知功能的影响[J].安徽医学,2016,37(9):1099-1101.
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