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©The Author(s) 2018.
世界华人消化杂志. 2018-04-08; 26(10): 609-615
在线出版 2018-04-08. doi: 10.11569/wcjd.v26.i10.609
在线出版 2018-04-08. doi: 10.11569/wcjd.v26.i10.609
表1 患者一般情况及麻醉时间比较
| 分组 | 病例数 (n) | 性别 | 年龄 (岁) | ASA分级 | 麻醉时间 (min) | ||
| 男 | 女 | Ⅰ 级 | Ⅱ级 | ||||
| 实验组 | 29 | 20 | 9 | 63.3 ± 9.6 | 10 | 19 | 215.5 ± 15.2 |
| 对照组 | 29 | 19 | 10 | 62.8 ± 10.1 | 9 | 20 | 208.9 ± 14.8 |
| t/χ2 | t<0.001 | χ2 = 0.0783 | t = 0.1932 | χ2<0.001 | t = 1.6753 | ||
| P值 | >0.05 | >0.05 | >0.05 | >0.05 | >0.05 | ||
表2 两组患者术前、术后生命体征及镇痛泵按压次数比较
| 分组 | 病例(n) | 死亡病例(n) | 血压(mmHg) | 心率(次/min) | 血氧饱和度(%) | 镇痛泵按压(次数/次) |
| 实验组 | 29 | 1 | ||||
| 术前3 h | 117.2 ± 3.5/84.5 ± 4.7 | 76.4 ± 7.2 | 99.3 ± 0.6 | 0 | ||
| 术后3 h | 132.3 ± 6.5/94.3 ± 5.2 | 92.5 ± 10.9 | 96.7 ± 1.8 | 1.5 ± 0.5 | ||
| 术后12 h | 129.3 ± 5.4/87.9 ± 5.1 | 88.3 ± 8.6 | 97.6 ± 1.1 | 3.2 ± 1.1 | ||
| 术后48 h | 113.5 ± 5.9/85.8 ± 5.5 | 80.2 ± 6.8 | 98.3 ± 1.2 | 4.3 ± 1.2 | ||
| 对照组 | 29 | 1 | ||||
| 术前3 h | 115.2 ± 4.5/86.5 ± 3.7 | 75.1 ± 8.2 | 99.5 ± 0.7 | 0 | ||
| 术后3 h | 136.5 ± 7.5/97.8 ± 5.9 | 98.1 ± 9.5 | 95.7 ± 1.6 | 2.5 ± 0.7 | ||
| 术后12 h | 132.5 ± 6.4/92.9 ± 6.1 | 94.9 ± 9.8 | 96.6 ± 2.1 | 4.2 ± 1.3 | ||
| 术后48 h | 119.5 ± 6.9/89.5 ± 6.2 | 87.4 ± 7.8 | 97.4 ± 1.7 | 5.3 ± 1.9 | ||
| t值 | ||||||
| t0 | <0.001 | <0.001 | 1.8564/1.4628 | 0.6304 | 1.1479 | 0 |
| t3 | 2.2393/2.2876 | 2.0494 | 2.6366 | 6.1512 | ||
| t12 | 2.0221/3.3275 | 2.6785 | 2.2321 | 3.1073 | ||
| t48 | 3.4971/2.3623 | 3.6818 | 2.2886 | 2.3547 | ||
| P3、12、48 | >0.05 | >0.05 | <0.05 | <0.05 | <0.05 | <0.05 |
表3 手术前后MMSE、VAS、BCS评分及POCD发生率比较
| 分组 | 病例数(n) | 死亡病例(n) | MMSE | POCD n (%) | VAS | BCS |
| 实验组 | 29 | 1 | ||||
| 术前1 d | 29.8 ± 2.5 | 0 | 1.2 ± 0.2 | 3.7 ± 0.9 | ||
| 术后1 d | 23.7 ± 2.1 | 4 (14.3) | 3.4 ± 0.7 | 3.6 ± 0.7 | ||
| 术后3 d | 25.1 ± 3.1 | 3 (10.7) | 4.1 ± 1.2 | 2.9 ± 0.7 | ||
| 术后5 d | 27.3 ± 3.8 | 1 (3.6) | 4.9 ± 1.2 | 2.1 ± 0.9 | ||
| 术后10 d | 28.1 ± 4.1 | 0 | 5.0 ± 0.7 | 1.8 ± 0.5 | ||
| 对照组 | 29 | 1 | ||||
| 术前1 d | 30.0 ± 1.9 | 0 | 1.1 ± 0.2 | 3.8 ± 0.8 | ||
| 术后1 d | 22.1 ± 2.2 | 7 (25.0) | 3.9 ± 0.8 | 3.1 ± 0.8 | ||
| 术后3 d | 23.3 ± 3.2 | 5 (17.9) | 4.9 ± 1.3 | 2.1 ± 0.8 | ||
| 术后5 d | 24.0 ± 5.1 | 4 (14.3) | 5.6 ± 1.4 | 1.1 ± 0.5 | ||
| 术后10 d | 24.7 ± 5.2 | 2 (7.1) | 5.5 ± 0.8 | 0.8 ± 0.6 | ||
| t/χ2 | <0.001 | <0.001 | ||||
| t0 | 0.3370 | <0.001 | 1.8708 | 0.4394 | ||
| t1 | 2.7837 | 7.1795 | 2.4889 | 2.4889 | ||
| t3 | 4.2606 | 2.3927 | 3.9823 | |||
| t5 | 2.7452 | 2.0937 | 5.1396 | |||
| t10 | 2.7169 | 2.4889 | 6.7751 | |||
| P1、3、5、10 | >0.05 | >0.05 | <0.05 | <0.05 | <0.05 | <0.05 |
表4 影响术后患者认知功能的单因素分析
| 因素 | 例数 (n) | 认知功能障碍发生率 (%) | OR (95%CI) | P值 |
| 性别 | 0.894 (0.432-1.714) | >0.05 | ||
| 男 | 39 | 18.0 | ||
| 女 | 19 | 21.1 | ||
| 年龄 (岁) | 2.134 (1.0129-3.958) | <0.05 | ||
| <60 | 33 | 12.1 | ||
| ≥60 | 25 | 28.0 | ||
| ASA分级 | 1.308 (0.927-1.949) | >0.05 | ||
| Ⅰ级 | 19 | 21.1 | ||
| Ⅱ级 | 39 | 18.0 | ||
| 慢性疾病 | ||||
| 糖尿病 | 11 | 63.6 | 2.327 (1.053-3.439) | <0.05 |
| 高血压 | 15 | 13.3 | 1.351 (1.012-1.572) | >0.05 |
| 冠心病 | 19 | 10.5 | 1.042 (0.984-1.154) | >0.05 |
| 术中氧饱和度 (g/L) | 0.262 (0.105-2.682) | <0.05 | ||
| ≥95 | 50 | 10.0 | ||
| <95 | 8 | 75.0 | ||
| 麻醉时间 (min) | 0.778 (0.553-1.193) | >0.05 | ||
| <200 | 30 | 20.0 | ||
| ≥200 | 28 | 17.9 | ||
| 术后镇痛作用 | 3.627 (1.153-6.439) | <0.05 | ||
| 有效 | 40 | 7.5 | ||
| 无效 | 18 | 44.4 |
引文著录: 梁磊. 肋间神经阻滞改善老年食管癌患者术后疼痛及对认知障碍的临床影响. 世界华人消化杂志 2018; 26(10): 609-615