右美托咪定复合舒芬太尼自控静脉镇痛对老年脊柱手术患者术后认知功能的影响  

Effects of patient-controlled intravenous analgesia with dexmedetomidine and sufentanil on postoperative cognition in elderly patients after spine surgery

作　　者：王昆[1] 李成文[1] 史继红[2] 卫宏图[3] 

机构地区：[1]济宁市第一人民医院麻醉科,山东省济宁市272011 [2]济宁市第一人民医院心理门诊,山东省济宁市272011 [3]济宁市第一人民医院骨科,山东省济宁市272011

出　　处：《中华医学杂志》2015年第30期2437-2441,共5页National Medical Journal of China

基　　金：山东省自然科学基金（ZR2010HQ007）

摘　　要：目的 评价右美托咪定复合舒芬太尼患者静脉自控镇痛（PCIA）对老年脊柱手术患者术后早期认知功能的影响.方法 全麻下择期脊柱手术老年患者152例,年龄＞60岁,美国麻醉医师协会（ASA）分级Ⅰ～Ⅲ级,随机分为2组：S组仅采用舒芬太尼实施PCIA（n=77）;D组采用右美托咪定复合舒芬太尼实施PCIA（n =75）.于术后1、2、6、12、24和48 h采用11点数字评分（NRS）评估患者静息和翻身活动时的疼痛程度;于术后1～3d采用意识错乱评估法（CAM）评估术后谵妄（POD）的发生情况;于术前1d和术后1周进行韦氏记忆量表数字广度及视觉再认和联想学习分测验（包括顺背数字、倒背数字、视觉再认、联想学习）、Stroop色码干扰测验、韦氏成人智力量表数字符号替代分测验（DSST）、数字连线测验（Part A）等神经认知测验,评估术后认知功能障碍（POCD）的发生情况.结果 D组静息NRS评分和活动NRS评分自术后6h均低于S组（均P＜0.05）.S组和D组分别有8例（10.4％）和3例（4.0％）患者发生POD,差异无统计学意义（x2=1.457,P＞0.05）,且S组有2例POD患者需采用利培酮治疗.S组和D组分别有15例（19.5％）和6例（8.0％）患者出现POCD,差异有统计学意义（x2=4.206,P＜0.05）.S组术后1周的倒背数字评分、视觉再认评分、DSST评分和Stroop测验完成时间分别为（3.7±1.3）分、（7.7±2.0）分、（25.2±7.8）分和（56.9±14.8）s,与术前的（4.1±1.1）分、（8.8±1.8）分、（28.2±7.6）分和（50.2±14.7）s比较,差异有统计学意义（t=2.132、3.585、2.427、-2.822,均P＜0.05）,而D组仅倒背数字评分与术前比较显著下降[（3.6±1.2）分比（4.0±1.2）分,t=2.144,P＜0.05].结论 右美托咪定复合舒芬太尼PCIA可改善老年脊柱手术患者的术后镇痛效果和术后早期认知功能.Objective To explore the effect of patient-controlled intravenous analgesia （PCIA） with dexmedetomidine and sufentanil on early postoperative cognition in elderly patients after spine surgery.Methods One hundred fifty-two patients aged more than 60 yr with ASA Ⅰ-Ⅲ undergoing eiective spine surgery were randomly assigned into two groups：Group S received PCIA with only sufentanil （n =77）;Group D received PCIA with dexmedetomidine and sufentanil （n =75）.The severity of pain at rest and upon movement was measured at 1,2,6,12,24 and 48 h after surgery using the 11-point numerical rating scale （NRS）.Delirium was assessed daily within three days after surgery via the confusion assessment method.Cognitive function was measured at the day before surgery and at one week after surgery using a battery of neuropsychologic tests including Digit Span （forward and backward） subtests and Visual Retention and Paired Associate Verbal Learning subtests of Wechsler Memory Scale,Stroop Color Word Interference Test,Digit Symbol Substitution subtest of Wechsler Adult Intelligence Scale （DSST） and Trail Making Test （Part A）.Results The NRS scores at rest and upon movement at 6 to 48 h after surgery were lower in Group D than those in Group S （P 〈 0.05）.Postoperative delirium （POD） was present in 8 （10.4%） patients in Group S and 3 （4.0%） patients in Group D （x2 =4.206,P 〉 0.05）.Two patients with POD in Group S were treated with risperidone.Postoperative cognitive dysfunction （POCD） was present in 15 （19.5%） patients in Group S and 6 （8.0%） patients in Group D （x2 =4.206,P 〈 0.05）.Compared with the preoperative baselines,the scores of Digit Span backward,Visual Retention and DSST were significantly lower（3.7 ±1.3 vs4.1 ±1.1,7.7±2.0 vs8.8 ±1.8,25.2±7.8 vs28.2±7.6;t=2.132,3.585,2.427,respectively,P 〈 0.05） and the time to complete Stroop test was significantly longer in Group S （56.9 ± 14.8 vs 50.2 ± 14.7,t =-2.822,P 〈 0.05）,while only the score

关 键 词：老年人 认知障碍 患者自控镇痛 右美托咪定 舒芬太尼 

分 类 号：R614[医药卫生—麻醉学]