右美托咪定复合地佐辛静脉自控镇痛对高龄骨科患者术后睡眠和认知的影响  

Effect of dexmedetomidine and dezocine in patient-controlled intravenous analgesia on postoperative sleep quality and cognition of elderly patients

作　　者：卢飞飞 冯秀梅 曹永 李言民 程伟 LU Feifei;FENG Xiumei;CAO Yong;LI Yanmin;CHENG Wei(Department of Anesthesiology,Xuzhou City Hospital of Traditional Chinese Medicine,Xuzhou 221009,Jiangsu,China;Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221004,Jiangsu,China)

机构地区：[1]徐州市中医院麻醉科,江苏徐州221009 [2]徐州医科大学附属医院麻醉科,江苏徐州221002

出　　处：《外科研究与新技术》2021年第1期52-56,共5页Surgical Research and New Technique

基　　金：国家自然科学基金项目(81200858);徐州市科技创新项目(KC19023)。

摘　　要：目的探讨右美托咪定(dexmedetomidine,Dex)联合地佐辛术后患者静脉自控镇痛(patientcontrolled intravenous analgesia,PCIA)对高龄椎管内麻醉骨科患者术后睡眠质量及早期认知功能的影响。方法择期实施椎管内麻醉的骨科高龄患者,年龄80~96岁,采用随机数字表法分成两组:地佐辛组、地佐辛+Dex组。最终入组65例,地佐辛组32例,地佐辛+Dex组33例。于术前、术后24 h、48 h及出院前进行匹兹堡睡眠质量指数(PSQI)评分,术后4、8、12、24和48 h的视觉模拟评分(VAS)及镇静(Ramsay)评分。并于术前1 d和术后1、3、7 d分别测定简易精神状态评价量表(MMSE)评分和术后认知功能障碍的发生情况。评价术后恶心、呕吐、嗜睡及导尿管不适等的发生率。结果地佐辛+DEX组患者术后24 h、48 h和出院前PSQI评分明显低于地佐辛组(P<0.05)。地佐辛+DEX组术后Ramsay评分明显高于地佐辛组(P<0.05);地佐辛+DEX组术后MMSE评分较高,POCD发生率低于地佐辛组(P<0.05)。地佐辛+DEX组VAS评分降低,术后恶心、呕吐及导尿管不适等副作用发生率较低(P<0.05)。结论高龄手术患者术后应用Dex联合地佐辛PCIA有利于改善患者术后睡眠障碍,且认知功能障碍发生率低。Objective To investigate the effect of dexmedetomidine(Dex)combined with dezocine in patientcontrolled intravenous analgesia(PCIA)on the quality of sleep and the early cognitive function of elderly patients with spinal anesthesia after operation.Methods Sixty-five elderly patients aged 80-96 years undergoing spinal anesthesia from the department of orthopedics were randomly divided into two groups by random table method:dezocine group(group C,n=32)and dezocine plus Dex group(group D,n=33).Pittsburgh sleep quality index(PSQI)was assessed at preoperation,24 h and 48 h postoperation,and before discharge,respectively.Visual Analogue Scale(VAS)score and Ramsay score were observed 4,8,12,24,and 48 h after surgery,respectively.Mini-Mental Status Examination(MMSE)score was recorded at 1d before surgery and 1,3,7 d after surgery,respectively,and the incidence rate of postoperative cognitive dysfunction was evaluated as well.The postoperative incidence rates of nausea,vomiting,somnolence,and urinary catheter discomfort were also evaluated.Results The PSQIs in the group D at postoperative 24 h and 48 h and before discharge were significantly lower than those in the group C(P<0.05).The postoperative Ramsay score in the group D was significantly higher than that in the group C(P<0.05).The postoperative MMSE scores in the group D were also significantly higher(P<0.05),and the incidence rate of POPD was lower(P<0.05).The group D showed a lower VAS score,and less nausea,vomiting,urinary catheter discomfort incidence rates(P<0.05).Conclusion Dex combined with dezocine in PCIA help improve the quality of sleep and reduce postoperative cognitive dysfunction in elderly patients.

关 键 词：右美托咪定 高龄 患者自控静脉镇痛 睡眠质量 认知 椎管内麻醉 

分 类 号：R614.4[医药卫生—麻醉学]