盐酸甲氯芬酯对老年女性患者全麻后复苏以及早期认知功能的影响
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摘要
目的观察盐酸甲氯芬酯对老年女性患者术后复苏及术后早期认知功能的作用。方法择期全麻下行子宫切除术的女性患者60例,随机分为试验组(MH组)及对照组(NS组)各30例。MS组手术结束时静脉推注盐酸甲氯芬酯250mg,NS组推注等量生理盐水。记录两组一般情况、气管导管拔除时间、拔管后Steward苏醒评分、恢复室出室时间等。所有患者分别于术前1天、术后24 h、术后72 h,出院前接受简易精神状态量表(MMSE)神经心理测试。结果与NS组相比,MH组呼之睁眼时间、指令反应时间、定向反应时间、气管导管拔除时间及恢复室出室时间均较短(P <0. 05),拔管后Steward苏醒评分更优(P <0. 05)。两组术后24 h MMSE评分均低于术前24 h(P <0. 05),但两组间比较,差异无统计学意义(P> 0. 05)。与未发生POCD的患者比较,发生POCD的患者年龄较大,受教育程度较低,ASA分级较高,差异有统计学意义(P <0. 05)。结论盐酸甲氯芬酯对术后早期认知功能障碍有一定预防作用;同时有促进全麻后复苏的作用,拔管时间缩短且清醒状态较好。
Objective To observe the effect of meclofenoxate hydrochloride on early postoperative cognitive dysfunction( POCD) of elderly female patients under general anesthesia.Methods Sixty patients undergoing total hysterectomy were randomly divided into NS group and MH group,30 in each group.The MS group was injected with 250 mg meclofenoxate hydrochloride while the NS group was injected with equal volume of saline at the end of surgery.The general situation of the patients,extubation time,Steward wakes up scoring after the tracheal extubation and length of stay in the post-anesthesia care unit( PACU) were recorded.All patients received the MMSE neuropsychological tests to evaluate their cognitive functions on the day before operation( T0),24 h( T1) and 72 h( T2) after operation and before hospital discharge( T3).Results Compared to the NS group,eye opening time upon calling,directional response time,oriented response time,extubation time and stay time at PACU in the MH group were significantly shorter and Steward wakes up scoring was better( P < 0. 05).The scores of mini-mental state examination after 24 hours of surgery in both groups were lower than that before 24 hours of surgery( P < 0. 05). There was no statistical difference between the two groups( P > 0. 05). Compared to patients without POCD,POCD patients were older,lower education,higher level of ASA grading( P < 0. 05).Conclusion Meclofenoxate hydrochloride has a preventive effect on the early POCD.At the same time,it has the effect of resuscitation after general anesthesia,and the time of extubation is shorter and the sober state is better.
Objective To observe the effect of meclofenoxate hydrochloride on early postoperative cognitive dysfunction( POCD) of elderly female patients under general anesthesia.Methods Sixty patients undergoing total hysterectomy were randomly divided into NS group and MH group,30 in each group.The MS group was injected with 250 mg meclofenoxate hydrochloride while the NS group was injected with equal volume of saline at the end of surgery.The general situation of the patients,extubation time,Steward wakes up scoring after the tracheal extubation and length of stay in the post-anesthesia care unit( PACU) were recorded.All patients received the MMSE neuropsychological tests to evaluate their cognitive functions on the day before operation( T0),24 h( T1) and 72 h( T2) after operation and before hospital discharge( T3).Results Compared to the NS group,eye opening time upon calling,directional response time,oriented response time,extubation time and stay time at PACU in the MH group were significantly shorter and Steward wakes up scoring was better( P < 0. 05).The scores of mini-mental state examination after 24 hours of surgery in both groups were lower than that before 24 hours of surgery( P < 0. 05). There was no statistical difference between the two groups( P > 0. 05). Compared to patients without POCD,POCD patients were older,lower education,higher level of ASA grading( P < 0. 05).Conclusion Meclofenoxate hydrochloride has a preventive effect on the early POCD.At the same time,it has the effect of resuscitation after general anesthesia,and the time of extubation is shorter and the sober state is better.
引文
[1]Dodds C,Allison J.Postoperative cognitive deficit in the elderly surgical patient[J].Br J Anaesth,1998,8 1(3):449-462.
[2]Zs-Nagy I.A survey of the available data on a new nootropic drug,BCE-001[J].Ann NY A cad Sci,1994,717(1):102-105.
[3] Petersen RC,Doody R,Kurz A,et al. Current concepts inmild cognitive impairment.Arch Neurol,2001,58(12):1985-1992.
[4]卞鑫,刘宇,姜卓颖.盐酸甲氯芬酯联合石杉碱甲治疗轻中度血管性痴呆的临床观察[J].上海医药,2004,25(9):409-411.
[5]Zhongcong Xie,Rudolph E,Tanzi.Alzheimer's disease and post-operative cognitive dysfunction[J]. Experimental Gerontology,2006,4(1):346-352.
[6]王东信,吴新民,李军,等.利多卡因对心脏手术后患者早期认知功能障碍发生率的影响[J].中华麻醉学杂志,2004,24(2):85-89.
[7]杨春水,陈俊宁.氯酯醒清除羟自由基的体外实验研究[J].南通医学院学报,1994,14(2):176-179.
[8] Moiler JT,Cluitmans P,Rasmussen LS,et al. long—term postoperative cognitive dysfunction in the elderly ispocd study.ispocd investigators. international study of post operative cognitive dysfunction[J].Lancet,1998,351(9106):857-861.
[2]Zs-Nagy I.A survey of the available data on a new nootropic drug,BCE-001[J].Ann NY A cad Sci,1994,717(1):102-105.
[3] Petersen RC,Doody R,Kurz A,et al. Current concepts inmild cognitive impairment.Arch Neurol,2001,58(12):1985-1992.
[4]卞鑫,刘宇,姜卓颖.盐酸甲氯芬酯联合石杉碱甲治疗轻中度血管性痴呆的临床观察[J].上海医药,2004,25(9):409-411.
[5]Zhongcong Xie,Rudolph E,Tanzi.Alzheimer's disease and post-operative cognitive dysfunction[J]. Experimental Gerontology,2006,4(1):346-352.
[6]王东信,吴新民,李军,等.利多卡因对心脏手术后患者早期认知功能障碍发生率的影响[J].中华麻醉学杂志,2004,24(2):85-89.
[7]杨春水,陈俊宁.氯酯醒清除羟自由基的体外实验研究[J].南通医学院学报,1994,14(2):176-179.
[8] Moiler JT,Cluitmans P,Rasmussen LS,et al. long—term postoperative cognitive dysfunction in the elderly ispocd study.ispocd investigators. international study of post operative cognitive dysfunction[J].Lancet,1998,351(9106):857-861.