地佐辛自控镇痛泵术前应用对老年下肢骨折患者应激反应及认知功能的影响  

Effects of preoperative dezocine patient-controlled analgesia pump on stress response and cognitive function in elderly patients with lower extremity fractures

作　　者：厉永亮 林海燕 张玲玲 董伊隆 LI Yongliang;LIN Haiyan;ZHANG Lingling;DONG Yilong(The Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,Zhejiang,China;Ninghai Hospital of traditional Chinese Medicine,Ningbo 315600,Zhejiang,China)

机构地区：[1]温州医科大学附属第三医院,浙江温州325200 [2]宁海县中医医院护理部,浙江宁波315600

出　　处：《中国临床药理学与治疗学》2022年第3期302-306,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：2018温州市基础性科研项目(Y20180582)。

摘　　要：目的:探究术前应用地佐辛自控镇痛泵对老年下肢骨折患者应激反应及认知功能的影响。方法:选取2018年11月至2020年6月收治的80例老年下肢骨折手术患者,随机分为对照组、研究组,各40例。对照组麻醉前不进行自控镇痛泵,研究组术前进行地佐辛自控镇痛泵静脉镇痛,比较2组术后应激反应、认知功能及不良反应。结果:两组患者干预前认知功能MMSE评分、应激反应指标(皮质醇、肾上腺素)水平、炎症因子(IL-6、TNF-α)水平比较无明显差异(P>0.05)。术后各项指标比较,研究组术后12 h、24 h、3 d MMSE评分均高于对照组(P<0.05);术后12 h、24 h皮质醇、肾上腺素、IL-6、TNF-α水平均低于对照组(P<0.05);同时,研究组呼吸抑制、尿潴留、恶心呕吐发生率明显低于对照组(P<0.05)。结论:老年下肢骨折患者术前应用地佐辛自控镇痛泵,能显著减轻术后应激反应、降低炎症反应、改善术后认知功能、值得临床应用。AIM:To explore the effects of preoperative application of dezocine patient-controlled analgesia pump on stress response and cognitive function in elderly patients with lower extremity fractures.METHODS:A total of 80 elderly patients with lower extremity fractures who were treated from November 2018 to June 2020 were selected and randomly divided into a control group and a study group,40 cases in each.The control group was not given a patient-controlled analgesia pump before anesthesia,and the study group was given intravenous analgesia with a dezocine patient-controlled analgesia pump before surgery.The postoperative stress response,cognitive function and safety were compared between the two groups.RESULTS:There were no significant differences in cognitive function MMSE score,stress response index(cortisol,epinephrine)levels,and inflammatory factors(IL-6,TNF-α)levels between the two groups before intervention(P>0.05).Compared with the indexes after operation,the MMSE scores of the study group at 12 h,24 h and 3 days after operation were higher than those in the control group(P<0.05);The levels of cortisol,epinephrine,IL-6 and TNF-αin the study group were lower than those in the control group at 12 h and 24 h after operation(P<0.05);At the same time,the incidences of respiratory depression,urinary retention and nausea and vomiting in the study group were significantly lower than those in the control group(P<0.05).CONCLUSION:Preoperative application of dezocine patient-controlled analgesia pump in elderly patients with lower extremity fracture can significantly reduce postoperative stress response,reduce inflammatory response,and improve postoperative cognitive function,which is worthy of clinical application.

关 键 词：自控镇痛泵 老年下肢骨折 应激反应 认知功能 

分 类 号：R614[医药卫生—麻醉学]