系统分级复温措施对老年骨科手术患者认知功能、应激指标及神经功能的影响

摘要 目的：探讨系统分级复温措施对老年骨科手术患者认知功能、应激指标及神经功能的影响。方法：选取2020年6月～2022年6月华中科技大学同济医学院附属梨园医院老年骨科手术患者80例，参照随机数字表法分为对照组（n=40）、研究组（n=40）。对照组予以传统复温措施，研究组予以系统分级复温措施，统计比较两组围术期温度变化、手术前后认知功能评分、应激指标[去甲肾上腺素（NE）、肾上腺素（AD）]、神经功能相关指标[血清S100B蛋白（S100B）、髓鞘碱性蛋白（MBP）、神经元特异性烯醇化酶（NSE）]及寒战发生情况、恢复期相关指标。结果：麻醉诱导后、麻醉30 min、手术结束时研究组体温高于对照组（P＜0.05）；术后12 h、24 h、48 h研究组简易智力状态检查量表（MMSE）评分高于对照组（P＜0.05）；术后12 h、24 h、48 h研究组NE、AD水平较对照组低（P＜0.05）；术后12 h、24 h、48 h研究组血清S100B、MBP、NSE水平较对照组低（P＜0.05）；两组寒战发生分级比较差异有统计学意义（P＜0.05），且研究组寒战发生率明显低于对照组（P＜0.05）；研究组自主呼吸时间、气管拔管时间、睁眼时间及麻醉恢复室滞留时间均短于对照组（P＜0.05）。结论：系统分级复温措施可维持老年骨科手术患者体温平稳，减少寒战发生，改善术后认知功能及神经功能，减轻机体应激反应，缩短麻醉恢复时间。

Effects of Systematic Graded Rewarming Measures on Cognitive Function, Stress Index and Neurological Function in Elderly Patients Undergoing Orthopaedic Surgery

ABSTRACT Objective: To explore the effects of systemically graded rewarming measures on cognitive function,stress index and neurological function in elderly orthopedic surgery patients. Methods: A total of 80 elderly orthopedic surgery patients in Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology from June 2020 to June 2022 were selected and divided into control group (n=40) and study group (n=40) according to random number table method. The control group was given traditional rewarming measures, and the study group was given systemically graded rewarming measures. The perioperative temperature changes, preoperative and postoperative cognitive function scores, stress indicators [norepinephrine (NE), epinephrine (AD)], neurological function related indicators [serum S100B protein (S100B), myelin basic protein (MBP), neuron specific enolase (NSE)], and the incidence of chills and related indicators in the recovery period were statistically compared between the two groups. Results: The body temperature of the study group was higher than that of the control group after anesthesia induction, 30 minutes after anesthesia and the end of operation (P<0.05). The Mini Mental State Examination (MMSE) score of the study group was higher than that of the control group at 12 h, 24 h and 48 h after surgery (P<0.05). At 12 h, 24 h and 48 h after operation, the levels of NE and AD in the study group were lower than those in the control group (P<0.05); The levels of serum S100B, MBP and NSE in the study group were lower than those in the control group at 12 h, 24 h and 48 h after operation (P<0.05). There was a statistically significant difference in the grade of chills between the two groups (P<0.05), and the incidence of chills in the study group was significantly lower than that in the control group(P<0.05). The spontaneous respiration time, tracheal extubation time, eye opening time and anesthesia recovery room retention time in the study group were shorter than those in the control group (P<0.05). Conclusion: The system grading rewarming measures can keep the body temperature stable, reduce the occurrence of chills, improve the postoperative cognitive function and neurological function, reduce the stress response and shorten the recovery time of anesthesia in elderly orthopedic surgery patients.