主动保温对行髋关节手术的衰弱患者术后认知的影响

史晓 静1, 王瑞 刚2, 高 璐1
1.华北理工大学2.华北理工大学附属医院

摘要

目的：衰弱指的是老人生理储备的下降而导致机体易损性增加、抗应激能力减退的非特异性状态。衰弱老年人经历外界较小的刺激就可以导致一系列临床负性事件的发生[1-2]。它可以是高强度体力劳动的结果，也可能伴随慢性疾病(肿瘤、神经系统、自身免疫、消化、心脏或呼吸，甚至代谢和内分泌疾病)，以及本身是一种没有原因和已知病理生理途径的疾病。随着人口老龄化不断加重及外科的发展，麻醉、手术、监护技术的进步，已能对90岁这样高龄患者施行手术。对衰弱老年患者进行主动保温，减少手术应激，使得老年外科病人的死亡率较前明显降低。目前有关体温保护对术后认知功能的影响的临床研究较少，结论各不相同。本文就对衰弱老人髋关节手术主动保温与衰弱老人术后认知功能的影响进行阐述。

关键词

衰弱患者；主动保温；术后认知功能障碍；髋关节手术

参考

[1]WalstonJ,HadleyEC,FerrucciL,etal.Researchagendaforfrailtyinolderadults:towardabetterunderstandingofphysiologyandetiology:summaryfromtheAmericanGeriatricsSociety/NationalInstituteonAgingResearchConferenceonFrailtyinOlderAdults[J].JAmGeriatrSoc,2006,54(6):991-1001.DOI:10.1111/j.1532-5415.2006.00745.x.[2]CleggA,Youngj,lliffeS,etal.Frailtyinelderlypeople[J].Lancet,2013,381(9868):752-762.DOI:10.1016/S0140-6736(12)62167-9.GUY,GAOL,CHENY,etal.SanggenonCprotectsagainstcardiomyocytehypoxiainjurybyincreasingautophagy[J].Molecularmedicinereports,2017,16(6):8130-8136.[3]Ap6stoloJ,CookeR,Bohrowicz-CamposE,etal.Predictingriskandoutcomesforfrailolderadults:anumbrellareviewoffrailtyscreeningtools[J].JBIDatabaseSystemRevImplementRep,2017.15(4)：1154-1208.DOIilO.l1124/JBISRIR-2016-003018.[4]LIX,XUS,ZHOUL,etal.Home-basedexerciseinolderadultsrecentlydischargedfromthehospitalforcardiovasculardiseaseinChina:RandomizedClinicalTrial[J].NursRes,2015,64(4):246-255.[5]ClaudeSchwartz.Enhancedrecoveryafterposteriorminimallyinvasivetotalhiparthroplastywithcontinuousintraarticularanaesthesia[J].EuropeanJournalofOrthopaedicSurgery&TraumatologyOrthopedieTraumatologie,2018,28(4:suppl1):1-9.[6]AkersJL，DupnickAC，HillmanEL，etal.InadvertentPerioperativeHypothermiaRisksandPostoperativeComplications：ARetrospectiveStudy[J].AORNJ，2019,109(6)：741-747.[7]KURZA,SESSLERDI,LENHARDTR.Perioperativenormothermiatoreducetheincidenceofsurgical-woundinfectionandshortenhospitalization.StudyofWoundInfectionandTemperatureGroup[J].TheNewEnglandJournalofMedicine,1996,334(19):1209-1215.[8]BURTONJR,LEEAG,POTTERJF.Geriatricsforspecialists[M].Switzerland:SpringerInternationalPublishing,2017.[9]FriedLP,TangenCM,WalstonJ,etal.Frailtyinolderadults:evidenceforaphenotype[J].JGerontolABiolSciMedSci,2001,56(3):M146-M156.DOI:10.1093/gerona/56.3.M146.[10]P.Piech,P.Polak,M.Koziołetal.,“ComparisionoftreatmentoutcomesinisolatedinjuriesofACL(ACL)andinjuriesofACLconnectedwithdamagesofmenisci,conductedwithuseofKOOSscale,”JournalofEducation,HealthandSport,vol.7,no.4,pp.313–315,2017.[11]DaiJ,LiY.EffectofNursinginOperatingRoomCombinedwithIntraoperativeHeatPreservationInterventiononPreventionofIncisionInfectionandImprovementofHemodynamicsinPatientswithAnteriorCruciateLigamentInjuryandReconstructionunderKneeArthroscopy.ComputMathMethodsMed.2022Apr15;2022:2915157.doi:10.1155/2022/2915157.PMID:35465002;PMCID:PMC9033368.[12]J.Merrick,“Wetzler.Editorialcommentary:reinventingtheACL,”Arthroscopy:TheJournalofArthroscopicandRelatedSurgery,vol.32,no.2,pp.424–426,2016.[13]YIJ,LEIY,XUS,etal.Intraoperativehypothermiaanditsclinicaloutcomesinpatientsundergoinggeneralanesthesia:NationalstudyinChina[J].PLoSOne,2017,12(6):e0177221..[14]FOSSUMS,HAYSJ,HENSONMM.Acomparisonstudyontheeffectsofprewarmingpatientsintheoutpatientsurgerysetting[J].JPeriAnesthesiaNurs,2001,16(3):187-194.[15]PANNENBH.Normo-undhypothermieausanästhesiologischerSicht[Normothermiaandhypothermiafromananaesthesiologicalviewpoint][J].Anaesthesist,2007,56(9):940-944.[16]FUSL,CHENIH,CHENCS,etal.Factorsinfluencingmicrobialcoloniesintheairofoperatingrooms[J].BMCInfectDis,2018,18(1):4.[17]ANDERSENBM.PreventionofPostoperativeWoundInfections[J].Preventionandcontrolofinfectionsinhospitals,2018,377-437.[18]顾梅,龚荣花,尹恩静.腹腔镜直肠癌术中低体温相关因素及其护理进展[J].护士进修杂志,2012,27(10):878-880.[19]TOROSSIANA,VANGERVENE,GEERTSENK,etal.Activeperioperativepatientwarmingusingaself-warmingblanket(BARRIEREasyWarm)issuperiortopassivethermalinsulation:amultinational,multicenter,randomizedtrial[J].JClinAnesth,2016,34:547-554.[20]RAJAGOPALANS,MASCHAE,NAJ,etal.Theeffectsofmildperioperativehypothermiaonbloodlossandtransfusionrequirement[J].Anesthesiology,2008,108(1):71-77.[21]LAURONENSL,KALLIOMÃKIML,AHOAJ,etal.Thermalsuitinpreventingunintentionalintraoperativehypothermiaduringgeneralanaesthesia:arandomizedcontrolledtrial[J].ActaAnaesthesiolScand,2017,61(9):1133-1141.DOI:10.1111/aas.12945.[22]ClaudeSchwartz.Enhancedrecoveryafterposteriorminimallyinvasivetotalhiparthroplastywithcontinuousintraarticularanaesthesia[J].EuropeanJournalofOrthopaedicSurgery&TraumatologyOrthopedieTraumatologie,2018,28(4:suppl1):1-9.[23]廖莉芳，包真，许燕红，等．围手术期快速康复护理对腹腔镜患者术后的影响[J]．国际医药卫生导报，2019,25(9):1500-1503.[24]漆红，金丽，李强，等．快速康复外科护理对髋关节置换术后患者关节功能及生活质量的影响[J]．中华现代护理杂志，2020,26(10):1349-1353.[25]侯甜，张红波．体外循环心脏患者围术期护理中应用快速康复理念的效果分析[J]．国际医药卫生导报，2019,25(14):2293-2295.[26]曾智敏，凌晶，陶，等．快速康复理念指导人工髋关节置换术治疗老年股骨颈骨折的早期疗效分析[J]．中国骨与关节损伤杂志，2018,33(5):536-537.[27]喻耀华，林良青，林庆水.术前髂筋膜间隙阻滞持续镇痛对老年髋部骨折患者术后认知功能的影响[J].黑龙江医药，2020，33（6）：1350-1352.[28]郭曲练.临床麻醉学第4版[M].人民卫生出版社,2016.08:180.[29]陈靖军，张三虎，李克寒，等.盐酸右美托咪定对老年结肠癌患者术后认知功能的影响[J].中国实用医药，2012,7(6):171-172.[30]DongW,ChenMH,YangYH,etal.Theeffectsofdexmedetomi-dineonexpressionofinflammationfactorsinpatientswithradicalresectionongastriccancer[J].EurRevMedPharmacolSci,2017,21(15):3510-3515.1