加速康复外科理念对老年胆道术后患者谵妄及认知功能障碍的影响
Application of accelerated rehabilitation surgery concept in postoperative delirium and cognitive impairment in elderly patients with biliary tract surgery
孙永强 1杨堃1
作者信息
- 1. 650000 云南省昆明市,昆明医科大学第一附属医院麻醉科
- 折叠
摘要
目的 探讨加速康复外科理念在老年胆道术后谵妄及认知功能障碍中的应用价值.方法 回顾性选取2022年 2 月-2023 年 9 月昆明医科大学第一附属医院收治的全身麻醉气管插管下接受腹腔镜胆道手术的老年患者为研究对象.选择其中接受加速康复外科理念管理的 40 例患者为观察组,根据组间基线资料均衡可比的原则,选择其中接受常规管理的40例患者为对照组.对比分析两组患者干预后谵妄及认知功能障碍发生情况;术前及干预12h后,S-100B蛋白水平、认知功能OXPORD诱发电位仪指标及认知功能主观维度评分情况.结果 术前,两组患者S-100B 蛋白水平比较,差异无统计学意义(P>0.05);干预 12h后,两组患者S-100B 蛋白水平高于术前,但观察组低于对照组,差异有统计学意义(P<0.05).干预 12h后,观察组患者认知功能OXPORD诱发电位仪指标中的潜伏期短于对照组,波幅长于对照组,差异有统计学意义(P<0.05);观察组患者空间定向、时间定向、事物命名、注意力、语言、抽象思维以及反应能力等认知功能维度评分均高于对照组,差异有统计学意义(P<0.05).观察组谵妄及认知功能障碍发生率均低于对照组,差异有统计学意义(P<0.05).结论 针对老年胆道手术患者采取加速康复外科理念管理,可有效降低术后谵妄与认知功能障碍发生率,减少手术、麻醉等应激造成的神经功能损伤.
Abstract
Objective To explore the application value of the concept of accelerated rehabilitation surgery in the treatment of postoperative delirium and cognitive dysfunction in elderly patients undergoing biliary surgery.Methods Retrospective selection of elderly patients who underwent laparoscopic biliary surgery under general anesthesia and tracheal intubation at the First Affiliated Hospital of Kunming Medical University from February 2022 to September 2023 as the research subjects.Select 40 patients who received accelerated rehabilitation surgery concept management as the observation group,and based on the principle of balanced and comparable baseline data between groups,select 40 patients who received routine management as the control group.Compared and analyzed the occurrence of delirium and cognitive dysfunction in two groups of patients after intervention;Preoperative and 12 hours after intervention,the levels of S-100B protein,cognitive function OXPORD evoked potential indicators,and subjective dimension scores of cognitive function were evaluated.Results Before surgery,there was no statistically significant difference in the levels of S-100B protein between the two groups of patients(P>0.05).After 12 hours of intervention,the levels of S-100B protein in both groups of patients were higher than before surgery,but the observation group was lower than the control group,and the difference was statistically significant(P<0.05).After 12 hours of intervention,the latency of OXPORD evoked potential indicators in the observation group was shorter than that in the control group,and the amplitude was longer than that in the control group,with statistical significance(P<0.05).The cognitive function dimensions such as spatial orientation,temporal orientation,object naming,attention,language,abstract thinking,and reaction ability scores of the observation group patients were higher than those of the control group,and the difference was statistically significant(P<0.05).The incidence of delirium and cognitive dysfunction in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Adopting the concept of accelerated rehabilitation surgery for elderly patients undergoing biliary surgery can effectively reduce the incidence of postoperative delirium and cognitive dysfunction,and minimize neurological damage caused by stress such as surgery and anesthesia.
关键词
加速康复外科理念/老年人/胆道手术/术后谵妄/认知功能障碍Key words
Accelerated rehabilitation surgery concept/Aged/Biliary surgery/Postoperative delirium/Cognitive impairment引用本文复制引用
出版年
2024
NETL
NSTL
万方数据