童军 曹寅 蔡雁

[摘要] 目的 觀察丹参川芎嗪注射液对老年患者半髋置换术后认知功能的影响。 方法 选择2019年1—9月在我院接受半髋关节置换术的老年患者46例，按照随机数字表法分为研究组和对照组，每组各23例。研究组患者采用丹参川芎嗪注射液10 mL加入到5%的250 mL葡萄糖溶液中，静脉滴注，每日1次;对照组患者采用5%的葡萄糖溶液250 mL，静脉滴注，每日1次;两组患者均从入院开始用药直到术后1周。入院时（T1）、术前1 d（T2）、术后第1天（T3）、术后第3天（T4）、术后1周（T5），分别检测血红蛋白（Hb）、高敏C反应蛋白（hs-CRP）、D-二聚体（DD）水平。使用蒙特利尔认知功能评估量表（MoCA）评估患者入院时、术后1周、术后4周、术后3个月的认知功能，并将MoCA评分降低>2分记录为术后认知功能障碍（POCD），计算POCD发生率。 结果 T2～T5时，研究组hs-CRP、DD水平明显低于对照组（P<0.05）。术后1周、术后4周研究组MoCA评分明显高于对照组，POCD发生率明显低于对照组（P<0.05），术后3个月，两组MoCA评分及POCD发生率比较，差异无统计学意义（P>0.05）。 结论 丹参川芎嗪注射液可减轻患者术后炎症反应，缓解血液高凝状态，保护半髋置换老年患者术后认知功能。

[关键词] 丹参川芎嗪注射液;半髋置换术;高敏C反应蛋白;D-二聚体;术后认知功能障碍

[中图分类号] R614          [文献标识码] A          [文章编号] 1673-9701（2021）08-0029-04

Effect of Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection on cognitive function of elderly patients after hemi-hip replacement

TONG Jun1   CAO Yin2   CAI Yan3

1.Department of Orthopedics， Jiangbei Branch of Ningbo First Hospital（Ninth Hospital of Ningbo City）， Ningbo  315000， China; 2.Department of Anesthesiology， Jiangbei Branch of Ningbo First Hospital（Ninth Hospital of Ningbo City）， Ningbo   315000， China; 3.Department of Pharmacy， Jiangbei Branch of Ningbo First Hospital （Ninth Hospital of Ningbo City）， Ningbo   315000， China

[Abstract] Objective To observe the effect of Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection on cognitive function of elderly patients after hemi-hip replacement. Methods Forty-six elderly patients undergoing hemi-hip replacement from January to September 2019 in our hospital were selected. All patients were divided into a study group and a control group by random number table method， with 23 cases in each group. The patients in the study group were injected with 10 mL of Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection into 250 mL of glucose solution at 5% concentration intravenously once a day. The patients in the control group were given 250 mL of glucose solution at 5% concentration intravenously once daily. All medications were taken from admission until 1 week after surgery. At admission（T1）， 1 day before surgery（T2）， 1 day after surgery（T3）， 3 days after surgery（T4）， 1 week after surgery（T5）， hemoglobin（Hb） and high-sensitivity C response protein（hs-CRP） and D-dimer（DD） levels were detected. The patient′s cognitive function at admission， 1 week after surgery， 4 weeks after surgery， and 3 months after surgery were assessed using the montreal cognitive assessment scale（MoCA）. A decrease of MoCA score>2 points was recorded as postoperative cognitive dysfunction（POCD）， and the incidence of POCD was calculated. Results From T2 to T5， the levels of hs-CRP and DD in the study group were significantly lower than those in the control group（P<0.05）. At 1 week and 4 weeks after surgery， the MoCA score of the study group was significantly higher than that of the control group， and the incidence of POCD was significantly lower than that of the control group（P<0.05）. There was no significant difference in MoCA score and POCD incidence between the two groups at the 3 months after surgery（P>0.05）. Conclusion Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection can reduce postoperative inflammation， relieve blood hypercoagulability， and protect postoperative cognitive function in elderly patients with hemi-hip replacement.

[Key words] Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection; Hemi-hip replacement; High-sensitivity C-reactive protein; D-dimer; Postoperative cognitive dysfunction

术后认知功能障碍（Postoperative cognitive dysfunction，POCD）是一种表现为记忆力、集中力和信息处理能力方面发生障碍及人格发生改变的神经受损疾病[1]。有研究证实，外科手术后的神经炎症与认知功能下降有关，术后疼痛、术后谵妄也在POCD发生、发展中扮演了重要角色[2-4]。研究者在前期研究中發现，由于大脑缺血、缺氧，老年患者POCD发生率较高[5]。临床工作中，丹参川芎嗪注射液常用于改善大脑供血，可提高脑梗死患者的抗凝血因子水平，降低梗死区域炎症反应，促进神经功能恢复[6-7]。对于……