中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2014年
8期
52-53,54
,共3页
氯胺酮%术后认知功能障碍%老年患者%炎症因子%骨科手术
氯胺酮%術後認知功能障礙%老年患者%炎癥因子%骨科手術
록알동%술후인지공능장애%노년환자%염증인자%골과수술
Ketamine%Postoperative cognitive dysfunction%Elderly patients%Inflammatory factors%Orthopedic surgery
目的：研究小麻醉剂量氯胺酮预处理对骨科老年患者术后认知功能的影响。方法：选取本院骨科择期行下肢手术的56例65~80岁老年患者，按照随机数字表法将其分为对照组和氯胺酮组各28例，氯胺酮组行全麻诱导后，以0.25 mg/（kg·h）速度持续静脉泵注氯胺酮，对照组给予等容量生理盐水静脉泵注。检测术前1 d、术后6 h、24 h、48 h、72 h外周静脉血肿瘤坏死因子-α（TNF-α）和白细胞介素6（IL-6）水平，记录术前1 d、术后24 h、48 h、72 h简易智能状态检查量表（MMSE）评分，评价认知功能。结果：氯胺酮组术后6 h、24 h、48 h血浆TNF-α、IL-6升高程度及术后24 h、48 h、72 h术后认知功能障碍（POCD）发生率均明显低于对照组，比较差异均有统计学意义（P<0.05）。结论：小麻醉剂量氯胺酮预处理可以降低骨科手术患者术后早期POCD发生率，推测可能与氯胺酮的抗炎性反应有关。
目的：研究小痳醉劑量氯胺酮預處理對骨科老年患者術後認知功能的影響。方法：選取本院骨科擇期行下肢手術的56例65~80歲老年患者，按照隨機數字錶法將其分為對照組和氯胺酮組各28例，氯胺酮組行全痳誘導後，以0.25 mg/（kg·h）速度持續靜脈泵註氯胺酮，對照組給予等容量生理鹽水靜脈泵註。檢測術前1 d、術後6 h、24 h、48 h、72 h外週靜脈血腫瘤壞死因子-α（TNF-α）和白細胞介素6（IL-6）水平，記錄術前1 d、術後24 h、48 h、72 h簡易智能狀態檢查量錶（MMSE）評分，評價認知功能。結果：氯胺酮組術後6 h、24 h、48 h血漿TNF-α、IL-6升高程度及術後24 h、48 h、72 h術後認知功能障礙（POCD）髮生率均明顯低于對照組，比較差異均有統計學意義（P<0.05）。結論：小痳醉劑量氯胺酮預處理可以降低骨科手術患者術後早期POCD髮生率，推測可能與氯胺酮的抗炎性反應有關。
목적：연구소마취제량록알동예처리대골과노년환자술후인지공능적영향。방법：선취본원골과택기행하지수술적56례65~80세노년환자，안조수궤수자표법장기분위대조조화록알동조각28례，록알동조행전마유도후，이0.25 mg/（kg·h）속도지속정맥빙주록알동，대조조급여등용량생리염수정맥빙주。검측술전1 d、술후6 h、24 h、48 h、72 h외주정맥혈종류배사인자-α（TNF-α）화백세포개소6（IL-6）수평，기록술전1 d、술후24 h、48 h、72 h간역지능상태검사량표（MMSE）평분，평개인지공능。결과：록알동조술후6 h、24 h、48 h혈장TNF-α、IL-6승고정도급술후24 h、48 h、72 h술후인지공능장애（POCD）발생솔균명현저우대조조，비교차이균유통계학의의（P<0.05）。결론：소마취제량록알동예처리가이강저골과수술환자술후조기POCD발생솔，추측가능여록알동적항염성반응유관。
Objective:To study the effects of small-dose ketamine pretreatment on the cognitive function in elderly patients after orthopedic operation.Method:56 elderly patients(65-80 years old)in orthopedics for elective orthopedic lower limb surgery were randomly divided into the control group and the ketamine group,28 cases in each group.After induction of anesthesia,the ketamine group was given ketamine with 0.25 mg/(kg·h)by continuous intravenous infusion,the control group was given the same volume of saline.Tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were detected 1 d before surgery,after 6 h,24 h,48 h and 72 h in peripheral blood.Mini Mental State Examination(MMSE)score were recorded 1 d before surgery,after 24 h,48 h,72 h,and cognitive function were evaluated.Result:The plasma level of TNF-αand IL-6 in the ketamine group increased extent after 6 h,24 h,48 h and the incidence rate of POCD 24 h,48 h, 72 h after surgery were significantly lower than those in the control group,the differences were statistically significant (P<0.05).Conclusion:Low dose ketamine pretreatment can reduce the incidence of postoperative early POCD,presumably it is related to anti-inflammatory response.
