地佐辛联合舒芬太尼用于老年膝关节置换术后镇痛效果及其对认知功能的影响  

Effects of dezocine combined with sufentanil on postoperative analgesia and cognitive dysfunction in elderly patients after replacement of knee joint

作　　者：张双银[1] 罗炜[1] 石翊飒[1] 

机构地区：[1]兰州大学第二医院麻醉科,730030

出　　处：《实用疼痛学杂志》2014年第6期435-438,共4页Pain Clinic Journal

摘　　要：目的 观察地佐辛联合舒芬太尼用于老年膝关节置换术后患者静脉自控镇痛（PCIA）的效果与安全性及其对认知功能的影响.方法 在椎管内麻醉下行膝关节置换术的老年患者60例,随机分为地佐辛组（D组）、舒芬太尼组（S组）、地佐辛与舒芬太尼组（DS组）,每组20例.记录3组术后各时点VAS、Ramsay镇静评分及48 h内不良反应.分别于术前1d和术后各点对患者行MMSE评分.结果 术后6、12、24及48 h时DS组患者VAS评分低于D组和S组（P＜0.05）;术后3、6、12及24 h时D组与DS组Ramsay镇静评分高于S组（P＜0.05）;3组患者术后6、12、24 h时MMSE评分较术前降低（P＜0.05）,组间比较差异无统计学意义（P＞0.05）;术后DS组不良反应少于D组和S组（P＜0.05）.结论 地佐辛联合舒芬太尼用于老年膝关节置换手术后PCIA的镇痛效果良好,且不良反应少,同时不增加老年患者术后认知功能障碍的风险.Objective To investigate the effects of dezocine combined with sufentanil on post- operative intravenous patient-controlled analgesia and cognitive function in elderly patients after the replacement of knee joint. Methods Sixty elderly patients undergoing knee replacement surgery were randomly divided into 3 groups （n= 20 each） ： dezocine group （group D）, sufentanil group （group S） and dezocine combined with sufentanil group （group DS）. VAS, Ramsay sedation score, side-effects were recorded at each time points after the operation. The cognitive function was evaluated by MMSE at 1 day before the operation and at each time points after the operation. Results VAS was significantly lower in group DS than that in groups D and S at 6, 12, 24 and 48 h after the operation （P〈0. 05）; compared with group S, Ramsay sedation score was higher in group D and DS at 3, 6, 12 and 24 h after the operation（P〈0.05） ; MMSE score was lower at 6, 12 and 24 h after the opera- tion than that before the operation in all groups（P〈0.05）, and no difference was found between the 3 groups（P〉0. 05）. There were significantly fewer side-effects in group DS than that in groups D and S（P〈0.05）. Conclusion Dezocine combined with sufentanil for PCIA in elderly patients after orthopedie knee replaeement surgery can provide effective postoperative analgesia and fewer side- effects, mean while it don＇t increase the risks of cognitive dysfunction in elderly patients.

关 键 词：地佐辛 舒芬太尼 疼痛 手术后 镇痛 患者控制 认知障碍 

分 类 号：R749[医药卫生—神经病学与精神病学]