长托宁对老年冠心病患者腹部手术后早期认知功能的影响
장탁저대노년관심병환자복부수술후조기인지공능적영향
Impact of Penehyclibine Hydrochloride on abdominal early postoperative cognitive function of elderly patients with coronary heart disease
  • 万方数据
    中国医药导报 중국의약도보
    CHINA MEDICAL HERALD
    2014年 35期 15-19,24 ,共6页

    吴林纳%孟海兵%丁国友

    오림납%맹해병%정국우

    术后认知功能障碍%盐酸戊乙奎醚%心肌保护%冠心病 術後認知功能障礙%鹽痠戊乙奎醚%心肌保護%冠心病
    술후인지공능장애%염산무을규미%심기보호%관심병
    Postoperative cognitive dysfunction%Penehyclibine Hydrochloride%Myocardial protection%Coronary heart disease
    目的：评价不同剂量长托宁对老年冠心病患者腹部手术后早期认知功能的影响及心肌保护作用。方法选择2012年3月~2014年2月解放军第九四医院收治的120例拟行腹部开腹手术老年冠心病患者，随机分为A、B、C组和对照组，各组30例，A、B、C组和对照组分别于术前40 min给予肌注长托宁0.005、0.01、0.02 mg/kg及东莨菪碱0.006 mg/kg，观察各组给药前(T1)、给药30 min(T2)、手术30 min(T3)、术毕5 min(T4)心率(HR)、血压、心率变异性，术前、术后24 h心肌肌钙蛋白(cTnI)水平，术前及术后24、48、72 h简易精神状况检查(MMSE)评分及术后认知功能障碍(POCD)发生率。结果 T1~4各组HR、收缩压(SBP)、舒张压(DBP)和低频功率/高频功率(LF/HF)比值均有显著变化(P<0.05)，其中A组T2、T3 HR显著高于T1，B、C组T2 HR显著高于T1(P<0.05)；各组T3、T4 SBP均显著高于T1(P<0.05)；各组T3 DBP均显著高于T1(P<0.05)；各组T2、T3 LF/HF与T1比较差异均有统计学意义(P<0.05)；T1、T4各组间HR、SBP、DBP和LF/HF比值比较差异均无统计学意义(P>0.05)，T2、T3各组间HR、SBP和LF/HF比值比较差异均有统计学意义(P<0.05)，其中A、B、C组HR、SBP、LF/HF均低于对照组(P<0.05)，A、B、C组组间比较差异均无统计学意义(P>0.05)。各组术前、术后24 h外周血cTnI水平无显著变化，组间比较差异也无统计学意义(P>0.05)。 A组术前至术后72 h MMSE评分无显著变化(P>0.05)，B、C组和对照组术前至术后72 h MMSE评分有显著变化(P<0.05)，B、C组和对照组术后24、48、72 h MMSE评分均显著低于术前(P<0.05)；术后24、48、72 h各组间MMSE评分差异有统计学意义(P<0.05)，其中A组术后24、48 h MMSE评分均高于B组(P<0.05)，术后24、48、72 h MMSE评分均高于C组和对照组(P<0.05)，B组术后24、48 h MMSE评分均高于C组和对照组(P <0.05)。 A、B、C组和对照组POCD的发生率分别为6.67%、10.00%、26.67%、30.00%，差异有统计学意义(P<0.05)。结论老年冠心病患者术前肌注不同剂量长托宁均有心肌保护作用，长托宁可对患者术后认知功能产生剂量相关影响，小剂量长托宁对患者安全性更高。
    목적：평개불동제량장탁저대노년관심병환자복부수술후조기인지공능적영향급심기보호작용。방법선택2012년3월~2014년2월해방군제구사의원수치적120례의행복부개복수술노년관심병환자，수궤분위A、B、C조화대조조，각조30례，A、B、C조화대조조분별우술전40 min급여기주장탁저0.005、0.01、0.02 mg/kg급동랑탕감0.006 mg/kg，관찰각조급약전(T1)、급약30 min(T2)、수술30 min(T3)、술필5 min(T4)심솔(HR)、혈압、심솔변이성，술전、술후24 h심기기개단백(cTnI)수평，술전급술후24、48、72 h간역정신상황검사(MMSE)평분급술후인지공능장애(POCD)발생솔。결과 T1~4각조HR、수축압(SBP)、서장압(DBP)화저빈공솔/고빈공솔(LF/HF)비치균유현저변화(P<0.05)，기중A조T2、T3 HR현저고우T1，B、C조T2 HR현저고우T1(P<0.05)；각조T3、T4 SBP균현저고우T1(P<0.05)；각조T3 DBP균현저고우T1(P<0.05)；각조T2、T3 LF/HF여T1비교차이균유통계학의의(P<0.05)；T1、T4각조간HR、SBP、DBP화LF/HF비치비교차이균무통계학의의(P>0.05)，T2、T3각조간HR、SBP화LF/HF비치비교차이균유통계학의의(P<0.05)，기중A、B、C조HR、SBP、LF/HF균저우대조조(P<0.05)，A、B、C조조간비교차이균무통계학의의(P>0.05)。각조술전、술후24 h외주혈cTnI수평무현저변화，조간비교차이야무통계학의의(P>0.05)。 A조술전지술후72 h MMSE평분무현저변화(P>0.05)，B、C조화대조조술전지술후72 h MMSE평분유현저변화(P<0.05)，B、C조화대조조술후24、48、72 h MMSE평분균현저저우술전(P<0.05)；술후24、48、72 h각조간MMSE평분차이유통계학의의(P<0.05)，기중A조술후24、48 h MMSE평분균고우B조(P<0.05)，술후24、48、72 h MMSE평분균고우C조화대조조(P<0.05)，B조술후24、48 h MMSE평분균고우C조화대조조(P <0.05)。 A、B、C조화대조조POCD적발생솔분별위6.67%、10.00%、26.67%、30.00%，차이유통계학의의(P<0.05)。결론노년관심병환자술전기주불동제량장탁저균유심기보호작용，장탁저가대환자술후인지공능산생제량상관영향，소제량장탁저대환자안전성경고。
    Objective To evaluate the functional impact and the cardioprotective effect of different doses of Penehycli-bine Hydrochloride on abdominal early postoperative cognitive function of elderly patients with coronary heart disease. Methods 120 cases of elderly coronary patients undergoing abdominal laparotomy from March 2012 to February 2014 in NO.94 Hospital of People's Liberation Army were randomly divided into group A, B, C and the control group, with 30 cases in each group. Group A, B, C and the control group were given intramuscular injection of Penehyclibine Hy-drochloride 0.005, 0.01, 0.02 mg/kg and Scopolamine 0.006 mg/kg 40 min respectively before surgery. The periopera-tive heart rate (HR), blood pressure, heart rate variability before admin istration (T1), administered 30 min (T2), 30 min after operation (T3), postoperative 5 min (T4), the level of cardiac troponin (cTnⅠ) in preoperative and postoperative 24 h, the MMSE score in preoperative and postoperative 24, 48, 72 h, and the incidence of POCD in each group were ob-served. Results HR, SBP, DBP and LF/HF ratio in T1-4 of each group were significant changed (P< 0.05), of which, HR in T2, T3 of group A were significantly higher than those in T1, HR in T2 of group B, C were significantly higher than that in T1 (P< 0.05); SBP of each group in T3, T4 were significantly higher than that in T1 (P < 0.05);DBP of each group in T3 were significantly higher than&nbsp;that in T1 (P <0.05); LF/HF of each group in T2, T3 were significantly different with T1 (P<0.05); HR, SBP, DBP and LF/HF ratio of each group in T1, T4 were not significantly different (P> 0.05), HR, SBP, and LF/HF ratio of each group in T2, T3 were significantly different (P<0.05), HR, SBP, LF/HF of group A, B, C were lower than those in the control group (P<0.05), the differences among the three groups were not statistically significant (P>0.05). Peripheral blood cTnⅠ levels of each group in preoperative and postoperative 24 h did not change significantly, and among the three groups there were no significant differences (P>0.05). MMSE scores of group A from preoperative to postoperative 72 h did not change significantly (P> 0.05), MMSE scores among group, B, C and the control group from preoperative to postoperative 72 h were changed significantly (P<0.05), MMSE scores of group B, C and the control group in postop-erative 24, 48, 72 h were significantly lower than those in preoperative (P<0.05); MMSE scores among each group in postoperative 24, 48, 72 h were significantly different (P<0.05), the MMSE scores of group A in postoperative 24, 48 h were higher than group B (P<0.05), MMSE scores of group A in postoperative 24, 48, 72 h were higher than those in group C and the control group (P<0.05), MMSE scores in group B in postoperative 24, 48 h were higher than those in group C and the control group (P < 0.05). The incidence of POCD of group A, B, C and control group was 6.67%, 10.00%, 26.67%, 30.00% respectively, the differences were statistically significant (P<0.05). Conclusion Elderly pa-tients with coronary heart disease given intramuscular injection of different doses of Penehyclibine Hydrochloride before operation have cardioprotective effects, and Penehyclibine Hydrochloride can produce dose-related effects on postoper-ative cognitive function, low dose of Penehyclibine Hydrochloride is safer for patients.
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