2018 年第 11 期 第 13 卷

不同保温策略对老年开腹胃癌手术患者术后认知功能障碍的影响

Effects of different temperature maintenance strategies on postoperative cognitive dysfunction in elderly patients undergoing laparotomy for gastric cancer

作者：滕成玲赵玉吕德珍

英文作者：

单位：210000南京军区南京总医院麻醉科

英文单位：

关键词：胃癌根治手术；体温保护；术后认知功能障碍

英文关键词：

• 摘要：

• 【摘要】目的    探讨围术期不同保温策略（主动保温和被动保温）对接受开腹胃癌根治手术的老年患者术后认知功能障碍（POCD）的影响。方法    选取2015年12月至2017年12月期间于南京军区南京总医院普外科行择期开腹根治手术的92例老年胃癌患者作为研究对象，通过随机数字表法将患分为分为对照组（48例）和观察组（44例）。对照组术中采用无菌单、棉毯等进行常规被动保温；观察组术中采用充气保温毯进行主动保温。比较2组患者围术期体温改变以及简易智力状态检查量表（MMSE）、蒙特利尔认知评估量表(MoCA)、术后恢复质量评估量表（PORS）评分等认知功能相关指标。结果    麻醉诱导前2组患者的鼻咽温度差异无统计学意义（P＞0.05）。麻醉诱导后60 min和手术结束时观察组鼻咽温度明显高于对照组［（36.2±0.7）℃比（35.7±0.8）℃、（35.9±0.6）℃比（35.4±0.8）℃］，差异均有统计学意义（均P＜0.01）。术前2组患者的MMSE、MoCA、PQRS评分差异均无统计学意义（均P＞0.05）。术后3 d时，观察组MMSE、MoCA、PQRS评分均明显高于对照组［（28.2±1.8）分比（27.5±1.5）分、（25.4±2.1）分比（24.3±1.9）分、（18.3±3.6）分比（16.8±2.9）分］，差异均有统计学意义（均P＜0.05）。观察组低体温、术后寒战发生率均明显低于对照组［11.4%（5/44）比31.3%（15/48）、38.6%（17/44）比64.6%（31/48）］（均P＜0.05）。术后3 d内2组POCD、术后谵妄发生率差异均无统计学意义（均P＞0.05）。结论    对于老年开腹胃癌手术患者，围术期主动保温能够明显降低低体温和POCD发生率。

• 【Abstract】Objective    To analyzed the effects of different temperature maintenance strategies (active and passive) on postoperative cognitive dysfunction(POCD) in elderly patients undergoing radical surgery for gastric cancer. Methods    A total of 92 elderly gastric cancer patients undergoing radical laparotomy from December 2015 to December 2017 in Nanjing Military Region General Hospital were randomly divided into control group（n＝48） and observation group（n＝44）. The control group was treated with routine passive temperature maintenance strategy using aseptic sheet and cotton blanket. The observation group was treated with active temperature maintenance strategy using inflatable thermal blanket. Perioperative temperature changes were observed. Scores of Mini-Mental State Examination（MMSE）, Montreal Cognitive Assessment（MoCA） and Post-operative Quality Recovery Scale（PORS） were analyzed. Results    There was no significant difference of nasopharyngeal temperature between groups before anesthesia induction（P＞0.05）. At 60 min after anesthesia induction and the end of surgery, nasopharyngeal temperatures in the observation group were significantly higher than that in the control group［（36.2±0.7）℃ vs （35.7±0.8）℃, （35.9±0.6）℃ vs （35.4±0.8）℃］（P＜0.01）. MMSE, MoCA, PQRS scores showed no significant differences between groups before surgery（P＞0.05）. Three days after surgery, MMSE, MoCA, PQRS scores in the observation group were significantly higher than those in the control group［（28.2±1.8） vs （27.5±1.5）, （25.4±2.1） vs （24.3±1.9）, （18.3±3.6） vs （16.8±2.9）］（P＜0.05）. Incidences of hypothermia and shivering in the observation group were significantly lower than those in the control group［11.4%（5/44） vs 31.3%（15/48）, 38.6%（17/44） vs 64.6%（31/48）］（P＜0.05）. Incidences of POCD and delirium in 3 d after surgery showed no significant differences between groups（P＞0.05）. Conclusion    Active temperature maintenance can significantly reduce incidences of hypothermia and POCD in elderly gastric cancer patients undergoing radical surgery.