国际麻醉学与复苏杂志   2018, Issue (6): 5-5
    
老年骨科手术患者围麻醉期嗅觉改变与术后认知功能障碍的相关性研究
吴佳璇, 游志坚1()
1.汕头大学医学院第二附属医院
Correlation between olfactory and post-operative cognitive dysfunction of the elderly orthopedic surgery patients in the peri-anesthesia
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摘要:

目的 观察老年骨科手术患者围麻醉期嗅觉功能与认知功能的变化,探究两者的相关性。 方法 试验组为行骨科手术的老年患者30例,分别于麻醉前1 d、麻醉后3、7 d采用康涅狄格化学感觉临床研究中心(Connecticut Chemosensory Clinical Research Center, CCCRC)嗅觉功能检查法进行嗅觉功能测试,同时采用简易智能量表(Mini-Mental State Examination, MMSE)、霍普金斯词汇学习测验-修订版(Hopkins Verbal Learning Test-Revised, HVLT-R)、循迹连线测试(Trail Making Test, TMT)、斯特鲁普字色干扰测试(Stroop Color Word Test, SCWT)、数字符号编码测试(Digit-Symbol Coding Test, DSCT)以及语义流畅度测验(Verbal Fluency Test, VFT)进行认知功能评估。对照组为健康志愿者30例,分别于相同时间点完成上述所有测试。记录所有受试者的测试结果,并分析其相关性。 结果 与对照组比较,试验组患者麻醉后3、7 d的嗅觉识别分数明显下降,差异有统计学意义(P<0.05);麻醉后3 d,试验组患者较对照组MMSE、短时记忆及延时记忆能力下降,TMT值、SCWT值升高(P<0.05);麻醉后7 d,试验组患者较对照组延时记忆能力下降,TMT值升高(P<0.05)。直线相关分析显示,试验组患者麻醉后3 d嗅觉识别分数差值与认知功能中短时记忆、延迟记忆呈正相关。 结论 老年骨科手术患者全身麻醉后嗅觉损害以识别得分下降为主,认知功能损害以短时记忆、延时记忆和注意力下降为主,麻醉后嗅觉损害与认知功能损害呈正相关。

关键词: 老年人; 骨科手术; 围麻醉期; 嗅觉功能; 术后认知功能障碍
Abstract:

Objective To investigate the change of olfactory and cognitive function at the perianesthesia of elderly orthopedic surgery patients, and analyze the correlation between them. Methods Thirty elderly orthopedic surgery patients in the anesthesia group who were scheduled for orthopaedic surgery. They were also tested with the Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory assessment in the day before anesthesia, 3nd and 7th day post-anesthesia. The cognitive function of each case was assessed using a battery of neuropsychological tests including Mini-Mental State Examination(MMSE), Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test (TMT), Stroop Color Word Test (SCWT), Digit-Symbol Coding Test (DSCT) and Verbal Fluency Test(VFT). A total of 30 healthy volunteers were recruited under the same inclusion and exclusion criteria, as the control group. Neuropsychological tests were performed to the control group at the same time period as in patients group. Results Compared with the control group, the olfactory identification score was lower in the anesthesia group on 3rd and 7th post-anesthesia day respectively, the difference is statistically significant(P<0.05). On 3rd post-anesthesia day, the scores of MMSE, short-term retention, delayed retention were lower, the scores of the TMT, SCWT were higher(P<0.05). On 7th post-anesthesia day, the scores of short-term retention were lower and the TMT were higher(P<0.05). Linear correlation analysis showed that the different values of olfactory identification score were correlated positively with the different values of short-term retention and delayed retention on 3rd and 7th post-anesthesia day. Conclusions The olfactory dysfunction mainly presented with the decrease of the olfactory identification score of elderly orthopedic surgery patients in the peri-anesthesia. The cognitive dysfunction mainly presented with the decrease of short-term retention, delayed retention and the ability of concentrating. The olfactory dysfunction was positively correlated with the post-anesthesia cognitive dysfunction.

Key words: Aged; Orthopedics surgery; Perianesthesia; Olfactory function; Post-operative cognitive dysfunction