徐知菲　唐在荣　姚娟

[摘要] 目的 观察醒脑静注射液对老年髋部骨折患者术后早期认知功能的影响。 方法 选择腰-硬联合麻醉下择期行髋部骨折手术老年患者60例，随机分为醒脑静组（X组）与空白对照组（C组），每组30例。分别于术前（T0）、术后1 d（T1）、3 d（T2）和5 d（T3）以简易精神状态量表（MMSE）和谵妄评估法（CAM）对患者精神状态进行评测，并观察记录药物不良反应；两组患者术后行硬膜外腔自控镇痛。 结果 X组患者术后T1、T2 MMSE评分较C组高（P<0.05）；T3时两组患者评分无统计学差异（P>0.05）；CAM谵妄评估X组发生谵妄者1例，C组7例，谵妄发生率C组较X组高（23.3% vs 3.3%）（P<0.05）。两组患者未发现明显不良反应。 结论 醒脑静注射液具有较高的安全性，能够改善老年髋部骨折手术患者术后早期认知功能，可减少老年患者术后谵妄的发生率。

[关键词] 醒脑静注射液；老年；髋部骨折；认知功能

[中图分类号] R683 [文献标识码] B [文章编号] 1673-9701（2018）23-0126-03

Effect of Xingnaojing injection on early postoperative cognitive function in elderly patients with hip fractures

XU Zhifei TANG Zairong YAO Juan LIANG Dongliang JIN Feng

Department of Anesthesiology，Gaoyou Hospital of TCM in Jiangsu Province，Gaoyou 225600，China

[Abstract] Objective To observe the effect of Xingnaojing injection on early postoperative cognitive function in elderly patients with hip fractures. Methods 60 patients undergoing elective hip fracture surgery under combined spinal-epidural anesthesia were selected and randomly divided into Xingnaojing group（group X） and blank control group（group C）， with 30 cases in each group. The mental state of the patients was evaluated by the Mini-Mental State Scale （MMSE） and the delirium assessment method（CAM） before surgery（T0）， 1 d（T1）， 3 d （T2）， and 5 d（T3） after surgery. The adverse drug reactions were observed and recorded； The patient-controlled epidural analgesia was performed in both groups after surgery. Results The postoperative T1 and T2 MMSE scores in group X were higher than those in group C（P<0.05）； at T3， there was no statistical difference in the scores between the two groups（P>0.05）； according to CAM delirium assessment， there was 1 case with delirium in group X， and 7 cases in group C. The incidence rate of delirium was higher in group C than in group X（23.3% vs 3.3%）（P<0.05）. No obvious adverse reactions were found in both groups. Conclusion Xingnaojing injection has a higher safety， which can improve the early postoperative elderly cognitive function of patients undergoing hip fracture surgery， and can reduce the incidence rate of postoperative delirium in elderly patients.

[Key words] Xingnaojing injection；Elderly；Hip fractures；Cognitive function

術后认知功能障碍（postoperative cognitive dysfunction，POCD）为影响老年患者术后康复的常见并发症[1]，术后谵妄（postoperative delirium， POD）则为术后一种急性精神错乱状态，常急性发病，表现为注意力、认知能力、思维记忆、神经运动及睡眠功能短暂性脑功能紊乱，可影响患者术后康复、增加患者留院时间与医疗支出，是导致老年患者术后远期死亡率增加的严重并发症。老年髋关节手术患者术后发病率可高达16%～62%[2]。由于POCD发病机制尚不明确，因此，积极早期预防与干预显得尤为重要。本研究旨在观察中成药醒脑静注射液对术后髋部骨折老年患者早期认知功能的影响，以期为临床提供参考。

1 资料与方法

1.1 一般资料

研究获得本院医学伦理委员的批准（20160312），并与患者家属签署知情同意书。选择2016年3月～2017年12月本院髋部骨折老年患者60例，择期于腰-硬联合麻醉下行半髋置换术者43例、全髋置换术者17例，年龄65～80岁，ASAⅠ或Ⅱ级，男33例，女27例。……