丙帕他莫超前镇痛联合芬太尼术后静脉镇痛对老年患者术后认知功能的影响  

Effects of preemptive analgesia with propacetameol combined with venous pump of fentanyl for multimodal analgesia on postoperative cognitive function in old patients

作　　者：胡志超[1] 孔莉[1] 许鹏程[2] 李颖[1] 董晓辉[1] 

机构地区：[1]商丘市第一人民医院麻醉科,河南商丘476100 [2]徐州医学院江苏省麻醉学重点实验室,江苏徐州221002

出　　处：《中国新药与临床杂志》2015年第9期675-678,共4页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的观察丙帕他莫超前镇痛联合芬太尼术后患者自控静脉镇痛（PCIA）的多模式镇痛对老年患者术后认知功能的影响。方法择期全麻下行腹腔镜下胆囊切除手术的老年患者80例，ASAⅠ～Ⅱ级．随机分为两组，每组40例。丙帕他莫联合芬太尼组在麻醉诱导前15min予丙帕他莫2g加入氯化钠注射液100mL中静脉滴注。芬太尼组仅予氯化钠注射液100mL。两组麻醉诱导及维持方法相同，术毕均即接上PCIA泵，芬太尼15μg·kg^-1＋托烷司琼5mg进行术后镇痛。采用视觉模拟评分（VAS）评估术后两组的镇痛效果．并记录芬太尼追加量和按压PCIA泵次数，采用简易精神状态量表（MMSE）对患者进行认知功能评估。结果术后6、12、24和48h，丙帕他莫联合芬太尼组患者VAS均低于芬太尼组（P〈0．05），PCIA泵按压次数及芬太尼追加用量也低于芬太尼组（P〈0．05）。与术前相比，术后第1、2、3日两组MMSE评分均下降（P〈0．05），术后第5日无明显变化（P〉0．05）；术后第1、2、3日丙帕他莫联合芬太尼组MMSE评分高于芬太尼组（P〈0．05），术后第5日MMSE评分组间无显著差异（P〉0．05）。丙帕他莫联合芬太尼组和芬太尼组认知功能障碍发生率分别为12％和18％，组间无显著差异（P〉0．05）。结论丙帕他莫超前镇痛联合芬太尼PCIA镇痛可改善老年患者术后认知功能，但不能降低老年患者术后认知功能障碍的发生率。AIM To assess the effects of preemptive analgesia with propacetamol combined with fentanyl patient-controlled intravenous analgesia （PCIA） for multimodal analgesia on postoperative cognitive function in old patients. METHODS A total of 80 patients （ASA Ⅰ - Ⅱ） scheduled to undergo laparoscopic cholecystectomy under general anesthesia were randomly divided into two groups （n = 40） ： preemptive analgesia with propacetameol combined with fentanyl PCIA group （group PF） and fentanyl PCIA group （group F） . Fifteen minutes before the induction of anesthesia, patients in the group PF and group F received propacetameol 2 g in sodium chloride injection 100 mL and sodium chloride injection 100 mL only, respectively. Patients in both groups received the same anesthetic management. PCIA was initiated using fentanyl 15 μg.kg^-1 and tropisetron 5 mg. Visual analogue scales （VAS）, the number of PCIA pressing times and total fentanyl consumption after surgery were recorded. Cognitive function was assessed by minimental state examination （MMSE） . RESULTS VAS score at 6, 12, 24 and 48 h after surgery, the number of PCIA pressing times and total fentanyl consumption were significantly lower in the group PF than those in the group F （P 〈 0.05）. Compared with preoperative MMSE scores, MMSE scores on days 1, 2 and 3 after surgery were decreased （P 〈 0.05） in both groups. Moreover, the MMSE scores in the group F was markedly decreased as compared with those in the group PF （P 〈 0.05） . On day 5 after surgery, there were no significant difference between postoperative and preoperative MMSE scores, and between group PF and group F （P 〉 0.05） . There were no significant difference in the occurrence rate of postoperative cognitive dysfunction （POCD） between group PF （12%） and group F （18%, P 〉 0.05） . CONCLUSION Preemptive analgesia with propacetameol combined with fentanyl PCIA for multimodal analgesia may improve postoperative cognitive function in old patients withou

关 键 词：丙帕他莫 芬太尼 镇痛 老年人 认知 

分 类 号：R971[医药卫生—药品]