摘要
目的:评价术前认知训练对冠状动脉旁路移植术和/或瓣膜手术老年患者术后神经认知功能的影响。方法:择期全身麻醉下行冠状动脉旁路移植术和/或瓣膜手术老年患者74例,性别不限,ASA分级Ⅲ或Ⅳ级,年龄60~90岁,BMI 19~28 kg/m^(2),根据入院时间,采用区组随机化法分为2组(n=37):认知训练组(CT组)和对照组(C组)。CT组于术前完成认知训练1次·h^(-1)·d-1,连续5 d;C组术前不进行认知训练,常规护理。术后第7天,采用蒙特利尔认知评估量表(MoCA)评估神经认知功能,术后恢复质量量表(PQRS)评估术后恢复质量,记录2组患者术后并发症和死亡发生情况;术后第1和3个月采用老年抑郁量表(GDS)、MoCA和PQRS对患者进行评估。结果:CT组患者术后第7天、1和3个月时MoCA评分高于C组(P<0.05)。2组患者术后病死率和并发症发生率比较差异无统计学意义(P>0.05)。2组患者术后第7天时PQRS评分比较差异有统计学意义(P<0.05),术后第1和3个月时PQRS评分和GDS评分差异无统计学意义(P>0.05)。结论:术前认知训练可改善冠状动脉旁路移植术和/或瓣膜手术老年患者术后神经认知功能。
ObjectiveTo evaluate the effect of preoperative cognitive training on postoperative neurocognitive function in elderly patients undergoing coronary artery bypass grafting(CABG)and/or valve surgery.MethodsSeventy-four elderly patients of either sex,of American Society of Anesthesiologists Physical Status classificationⅢorⅣ,aged 60-90 yr,with body mass index of 19-28 kg/m^(2),scheduled for elective CABG or valve surgery under general anesthesia,were divided into 2 groups(n=37 each)using a computer-generated random number table method:cognitive training group(group CT)and control group(group C).Group CT was instructed to complete a cognitive training once 1 h per day for 5 consecutive days prior to surgery.Group C did not receive any cognitive training before surgery,and routine nursing was performed.At the 7th day after surgery,the patients′neurocognitive function was evaluated by the Montreal Cognitive Assessment Scale(MoCA),the Postoperative Quality Recovery Scale(PQRS)was used to assess the patients′recovery status,and the postoperative complications and morality in both groups were recorded.The patients were assessed using the Geriatric Depression Scale,MoCA and PQRS at the 1st month and 3rd month after operation.ResultsThe MoCA scores were significantly higher at the 7th day,1st month and 3rd month postoperatively than in group C(P<0.05).There was no significant difference in the postoperative case fatality rate and incidence of complications between the two groups(P>0.05).Significant difference was observed in PQRS scores between the two groups at the 7th day after surgery(P<0.05),but there were no significant differences in the PQRS scores and Geriatric Depression Scale scores between the two groups at the 1st month and 3rd month after operation(P>0.05).ConclusionsThe cognitive training can improve postoperative neurocognitive function in elderly patients undergoing CABG and/or valve surgery.
作者
王笠力
仇新缘
张雯
乔钰涵
凌菲
张月英
Wang Lili;Qiu Xinyuan;Zhang Wen;Qiao Yuhan;Ling Fei;Zhang Yueying(Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2024年第9期1097-1101,共5页
Chinese Journal of Anesthesiology
