CAJ | 학술논문

目的：探讨“通窍益脑方”对老年患者术后认知功能障碍（ POCD）的治疗效果和作用机制。方法选择全身麻醉下行骨科手术患者100例，按随机数字表分为“通窍益脑方”治疗组和对照组，每组50例。对照组常规治疗，不口服中药。治疗组在常规治疗基础上，每天2次口服中药汤剂“通窍益脑方”150 mL，连续服用15 d。采用简易智能状态检查法分别于麻醉前1 d及术后第1、3、7天评估患者认知功能，另于相应时间同时采血样检测患者的IL-6水平。结果两组术前基本情况差异无统计学意义。术后1 d，治疗组和对照组POCD发生率分别为30％和38％；术后3 d，治疗组和对照组POCD发生率分别为28％和20％；术后7 d，治疗组和对照组POCD发生率分别为20％和12％，两组差异有统计学意义（χ2＝4．332，P＝0．037）。与术前比较，两组术后3 d血清中IL-6含量均显著增加，差异有统计学意义（对照组，t＝2．412，P＝0．009；治疗组，t＝1．429，P＝0．039）；对照组术后7 d仍高于术前水平（t＝0．851，P＝0．049）；但是治疗组术后7 d已基本恢复，与术前差异无统计学意义（P＝0．404）；与对照组比较，治疗组术后3 d IL-6含量显著降低（t＝1．198， P＝0．035）。血清IL-6含量变化与MMSE评分负相关（r＝-0．782，P＝0．022）。结论“通窍益脑方”可有效改善老年患者术后认知功能障碍的症状，推测其作用机制可能与抑制血清中的IL-6有关。
목적：탐토“통규익뇌방”대노년환자술후인지공능장애（ POCD）적치료효과화작용궤제。방법선택전신마취하행골과수술환자100례，안수궤수자표분위“통규익뇌방”치료조화대조조，매조50례。대조조상규치료，불구복중약。치료조재상규치료기출상，매천2차구복중약탕제“통규익뇌방”150 mL，련속복용15 d。채용간역지능상태검사법분별우마취전1 d급술후제1、3、7천평고환자인지공능，령우상응시간동시채혈양검측환자적IL-6수평。결과량조술전기본정황차이무통계학의의。술후1 d，치료조화대조조POCD발생솔분별위30％화38％；술후3 d，치료조화대조조POCD발생솔분별위28％화20％；술후7 d，치료조화대조조POCD발생솔분별위20％화12％，량조차이유통계학의의（χ2＝4．332，P＝0．037）。여술전비교，량조술후3 d혈청중IL-6함량균현저증가，차이유통계학의의（대조조，t＝2．412，P＝0．009；치료조，t＝1．429，P＝0．039）；대조조술후7 d잉고우술전수평（t＝0．851，P＝0．049）；단시치료조술후7 d이기본회복，여술전차이무통계학의의（P＝0．404）；여대조조비교，치료조술후3 d IL-6함량현저강저（t＝1．198， P＝0．035）。혈청IL-6함량변화여MMSE평분부상관（r＝-0．782，P＝0．022）。결론“통규익뇌방”가유효개선노년환자술후인지공능장애적증상，추측기작용궤제가능여억제혈청중적IL-6유관。
Objective To investigate the effect of Tongqiao Yinao decoction ( TYD) on postoperative cogni-tive dysfunction in elderly patients and its underlying mechanisms .Methods 100 anesthetic patients for orthopedic surgery were randomly divided into the TYD-treated group and control group ,50 patients in each group .In TYD-trea-ted group,patients received 150mL TYD orally,twice daily for constitutive 15 days,beginning from the day of admis-sion in addition to conventional symptomatic and supportive treatment .While patients in control group received no TYD.Mini-mental state examination ( MMSE) was used to evaluate the patients′cognitive function before and after anesthesia.Meanwhile,blood samples of patients were also collected to test the expression levels of IL -6.Results There was no significant difference between the two groups before operation .However ,TYD-treated patients had signif-icantly lower incidence rate of POCD than the controls ( 20% in the control group , and 12% in the TYD-treated group;χ2 =4.332,P=0.037) 7 days after operation.The incidence rates of POCD in the TYD-treated group and control group were 30%and 38%1 day after operation ( P>0.05),28% and 20% 3 days after operation ( P>0.05),respectively.Compared with that before operation ,the blood levels of IL-6 in the two groups significantly increased 3 days after operation (control group,t=2.412,P=0.009;TYD-treated group,t=1.429,P=0.039).In contrast to the control group,the level of IL-6 in TYD-treated group declined to the baseline (the control group,t=0.851,P=0.049;TYD-treated group,P=0.404).Interestingly,compared with the controls,the TYD-treated patients had a significant lower level of IL-6 after operation (t=1.198,P=0.035).Furthermore,Pearson correlation analysis showed that change of IL-6 level in blood was negatively correlated with MMSE score (r=-0.782,P=0.022). Conclusion TYD can improve postoperative cognitive dysfunction in elderly patients ,presumably through decreasing the level of IL-6 in blood.