醒腦靜注射液對老年髖部骨折患者術后早期認知功能的影響

徐知菲　唐在榮　姚娟

[摘要] 目的 觀察醒腦靜注射液對老年髖部骨折患者術后早期認知功能的影響。 方法 選擇腰-硬聯合麻醉下擇期行髖部骨折手術老年患者60例，隨機分為醒腦靜組（X組）與空白對照組（C組），每組30例。分別于術前（T0）、術后1 d（T1）、3 d（T2）和5 d（T3）以簡易精神狀態量表（MMSE）和譫妄評估法（CAM）對患者精神狀態進行評測，并觀察記錄藥物不良反應；兩組患者術后行硬膜外腔自控鎮痛。 結果 X組患者術后T1、T2 MMSE評分較C組高（P<0.05）；T3時兩組患者評分無統計學差異（P>0.05）；CAM譫妄評估X組發生譫妄者1例，C組7例，譫妄發生率C組較X組高（23.3% vs 3.3%）（P<0.05）。兩組患者未發現明顯不良反應。 結論 醒腦靜注射液具有較高的安全性，能夠改善老年髖部骨折手術患者術后早期認知功能，可減少老年患者術后譫妄的發生率。

[關鍵詞] 醒腦靜注射液；老年；髖部骨折；認知功能

[中圖分類號] R683 [文獻標識碼] B [文章編號] 1673-9701（2018）23-0126-03

Effect of Xingnaojing injection on early postoperative cognitive function in elderly patients with hip fractures

XU Zhifei TANG Zairong YAO Juan LIANG Dongliang JIN Feng

Department of Anesthesiology，Gaoyou Hospital of TCM in Jiangsu Province，Gaoyou 225600，China

[Abstract] Objective To observe the effect of Xingnaojing injection on early postoperative cognitive function in elderly patients with hip fractures. Methods 60 patients undergoing elective hip fracture surgery under combined spinal-epidural anesthesia were selected and randomly divided into Xingnaojing group（group X） and blank control group（group C）， with 30 cases in each group. The mental state of the patients was evaluated by the Mini-Mental State Scale （MMSE） and the delirium assessment method（CAM） before surgery（T0）， 1 d（T1）， 3 d （T2）， and 5 d（T3） after surgery. The adverse drug reactions were observed and recorded； The patient-controlled epidural analgesia was performed in both groups after surgery. Results The postoperative T1 and T2 MMSE scores in group X were higher than those in group C（P<0.05）； at T3， there was no statistical difference in the scores between the two groups（P>0.05）； according to CAM delirium assessment， there was 1 case with delirium in group X， and 7 cases in group C. The incidence rate of delirium was higher in group C than in group X（23.3% vs 3.3%）（P<0.05）. No obvious adverse reactions were found in both groups. Conclusion Xingnaojing injection has a higher safety， which can improve the early postoperative elderly cognitive function of patients undergoing hip fracture surgery， and can reduce the incidence rate of postoperative delirium in elderly patients.

[Key words] Xingnaojing injection；Elderly；Hip fractures；Cognitive function

術后認知功能障礙（postoperative cognitive dysfunction，POCD）為影響老年患者術后康復的常見并發癥[1]，術后譫妄（postoperative delirium， POD）則為術后一種急性精神錯亂狀態，常急性發病，表現為注意力、認知能力、思維記憶、神經運動及睡眠功能短暫性腦功能紊亂，可影響患者術后康復、增加患者留院時間與醫療支出，是導致老年患者術后遠期死亡率增加的嚴重并發癥。老年髖關節手術患者術后發病率可高達16%～62%[2]。由于POCD發病機制尚不明確，因此，積極早期預防與干預顯得尤為重要。本研究旨在觀察中成藥醒腦靜注射液對術后髖部骨折老年患者早期認知功能的影響，以期為臨床提供參考。

1 資料與方法

1.1 一般資料

研究獲得本院醫學倫理委員的批準（20160312），并與患者家屬簽署知情同意書。選擇2016年3月～2017年12月本院髖部骨折老年患者60例，擇期于腰-硬聯合麻醉下行半髖置換術者43例、全髖置換術者17例，年齡65～80歲，ASAⅠ或Ⅱ級，男33例，女27例。……