不同药物用于老年病人术后镇痛的效果及对认知功能的影响

发布时间：2018-04-28 11:23

本文选题：术后认知障碍 + 老年病人　；参考：《郑州大学》2014年硕士论文

【摘要】：术后认知功能障碍(Postoperative cognitive dysfunction, POCD)是术后精神功能障碍(Postoperative psychonosema,POP)的一种临床表现,也是老年患者术后常见的一种中枢神经系统的并发症。表现为麻醉手术后记忆力、定向力、抽象思维能力障碍,同时伴有社会活动能力的减退,即人格、社交能力及认知能力和技巧的改变。随着老龄化逐渐成为中国发展的趋势,老年病人越来越多,尽管由于医疗技术水平和诊疗手段的提高使围手术期死亡率和多数严重并发症的发生率大大的降低,但是并没有明显改善对术后精神功能障碍的发生率。本研究旨在观察不同药物用于老年病人术后镇痛的效果及对认知功能的影响。目的比较舒芬太尼、氟比洛芬酯联合舒芬太尼分别用于老年人术后镇痛的镇痛效果以及对术后认知功能障碍的影响,旨在为老年患者探讨一种安全、有效的术后镇痛方法。方法选取普外科腹部手术(剔除腹腔镜手术)患者120例,ASAⅠ～Ⅲ级,排除神经统系疾病、精神病病史,年龄65-82岁,手术时间(117.9±53.63) min以内,麻醉方法为全身麻醉。随机分为两组(n=60)：舒芬太尼组(Ⅰ组)、舒芬太尼-氟比洛芬酯组(Ⅱ组)。患者术后清醒拔出气管导管(或者喉罩)后1小时,接入经静脉患者自控镇痛(Patient controlled intravenons analgesia, PCIA)泵镇痛。镇痛泵自控镇痛,背景剂量：4ml/h,按压剂量：3ml,锁定时间：15 min。舒芬太尼组(Ⅰ组)在镇痛泵中加入舒芬太尼2.5μg/kg+0.9%生理盐水200 ml;氟比洛芬酯-舒芬太尼组(Ⅱ组)在镇痛泵中加入氟比洛芬酯25 mg/kg+舒芬太尼1μg/kg+0.9%生理盐水200ml。在术前24小时(To),术后6小时(T1),术后24小时(T2),术后48小时(T3)各时间点分别进行MMSE和VAS评分及血液中p-淀粉样蛋白(Aβ)水平测定,并记录评分结果,并同时记录四个时间点的MAP、HR、SpO2,以及患者术后每日自行按压经静脉自控镇痛泵的次数。结果两组患者年龄、身高、体重、性别、手术时间、术前24小时MMSE评分、麻醉ASA分级比较,差异无统计学意义(P0.05)。组内比较：与To比较,Ⅰ组、Ⅱ组在T1、T2、T3各时点的平均动脉压(Mean arterial press,MAP)比较,差异无统计学意义(P0.05)；与To比较,Ⅰ组、Ⅱ组在T1、T2、T3各时点的心率(Heart rate,HR)比较,差异无统计学意义(P0.05)；与T0比较,Ⅰ组、Ⅱ组T1、T2、T3各时点的血氧饱和度(SpO2)比较,差异无统计学意义(P0.05)；与T0比较,Ⅰ组、Ⅱ组T1、T2、T3各时点的MMSE评分降低。差异有统计学意义(P0.05);与T0较比,Ⅰ组、Ⅱ组T1、T2、T3各时点的VAS升高,差异有统计学意义(P0.05)；与T0较比,Ⅰ组、ⅡⅡ组T1、T2、T3各时点的血液中p-淀粉样蛋白(Ap)水平均有所升高,差异有统计学意义(P0.05)。组间比较平均动脉压(MAP)比较：与Ⅰ组比较,Ⅱ组在T1、T2、T3各时点MAP降低,差异有统计学意义(P0.05)；心率(HR)比较：与Ⅰ组比较,Ⅱ组在T1、T2、T3各时点HR较高,差异有统计学意义(P0.05)；血氧饱和度(SpO2)比较：与Ⅰ组比较,Ⅱ组的SpO2在T1、T2、T3三个时间点的数值都较高；差异有统计学意义(P0.05)；VAS评分比较：,与Ⅰ组比较,Ⅱ组在To时间点的VAS评分比较,差异无统计学意义(P0.05)；与Ⅰ组比较,Ⅱ组在术后T1、T2、T3各时点的VAS评分降低(P0.05)。MMSE比较：与Ⅰ组比较,Ⅱ组在T0时点的MMSE评分比较,差异无统计学意义(P0.05)。与Ⅰ组比较,Ⅱ组在T1、T2、 T3各时点的MMSE评分较高,差异有统计学意义(P0.05);血液中β-淀粉样蛋白(Aβ)水平比较：与Ⅰ组比较,Ⅱ组在To时点的血液中p-淀粉样蛋白(Ap)水平比较,差异无统计学意义(P0.05)。与Ⅰ组比较,Ⅱ组在T1、T2、T3各时点的血液中p-淀粉样蛋白(Aβ)水平较低,差异有统计学意义(P0.05)；自控镇痛泵每12小时自行按压的次数比较：与Ⅰ组比较,Ⅱ组每日按压次数较多,差异有统计学意义(P0.05)。结论氟比洛芬酯联合舒芬太尼用于老年病人术后镇痛其镇痛效果良好,优于舒芬太尼单独用于老年病人术后镇痛的镇痛效果。氟比洛芬酯联合舒芬太尼用于老年病人术后镇痛在一定程度上减少不良反应的发生,同时也可以在一定程度上明显降低术后认知功能障碍的发生率。
[Abstract]:Postoperative cognitive dysfunction (Postoperative cognitive dysfunction, POCD) is a clinical manifestation of postoperative mental dysfunction (Postoperative psychonosema, POP). It is also a common complication of the central nervous system after the operation of the elderly. It is manifested in memory, orientation, and abstract thinking ability after anaesthesia. The decline in social activity, namely, personality, social ability and cognitive ability and skills, is becoming a trend in the development of China, with more and more elderly patients, although the rate of perioperative mortality and the incidence of most serious complications is greatly reduced, although the level of medical technology and diagnosis and treatment have greatly reduced the incidence of most serious complications. The purpose of this study was to observe the effect of different drugs on postoperative analgesia and cognitive function in elderly patients. Objective to compare the analgesic effects of sufentanil, flurbiprofen and sufentanil for postoperative analgesia and cognitive dysfunction after operation. The purpose of this study was to explore a safe and effective postoperative analgesia for the elderly patients. Methods 120 cases of abdominal surgery (excluding laparoscopy) in the Department of general surgery were selected, 120 patients were removed from the laparoscopy, ASA I to grade III, excluding the neurologic disease, the history of psychosis, the age of 65-82 years, the operation time (117.9 + 53.63) min, and general anesthesia. The anesthesia was divided into two randomly. Group (n=60): sufentanil group (group I), sufentanil - flurbiprofen group (Group II). Patients were sober out of the tracheal tube (or laryngeal mask) after 1 hours after surgery, access the intravenous patient-controlled analgesia (Patient controlled Intravenons analgesia, PCIA) pump analgesia. Analgesic pump self-control analgesia, the background dose: 4ml/h, compression dose: 3ml, locking time Room: 15 min. sufentanil group (group I) added sufentanil 2.5 Mu physiological saline 200 ml in the analgesia pump; flurbiprofen sufentanil group (Group II) added flurbiprofen ester 25 mg/kg+ sufentanil 1 ufentanil 1 u g/kg+0.9% physiological saline 200ML. at 24 hours before operation (To), 6 hours after operation (T1), 24 hours postoperative (T2), 48 small after operation. MMSE and VAS scores and the level of p- amyloid protein (A beta) in blood were measured at all time points (T3), and the results were recorded, and MAP, HR, SpO2, and the times of self controlled intravenous analgesia by self controlled intravenous analgesia were recorded at the same time at four time points. Results the age, height, weight, sex, operation time, 24 of the two groups were 24. Compared with To, group I, group I, group I, group I, group I and group II were compared with the mean arterial pressure (Mean arterial press, MAP) at T1, T2, T3, and there was no statistical difference (P0.05), compared to group I, group I, group I, group I, group I, group I, P0.05, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference, difference between MMSE and To. There was no statistical significance (P0.05); compared with T0, there was no statistical difference between group I, group II, T1, T2, and T3 at each time point of blood oxygen saturation (SpO2). Compared with T0, the MMSE scores of group I, group I, T1, T2, T3 were lower. Learning significance (P0.05); compared with T0, the level of p- amyloid protein (Ap) in the blood of group I and II II group T1, T2, T3 all increased, the difference was statistically significant (P0.05). Compared with the group I compared with the group I, the group II was lower in T1, T2, and T3 at each time point, and the difference was statistically significant. Compared with group I, group II was higher at T1, T2 and T3 at each time point, and the difference was statistically significant (P0.05); oxygen saturation (SpO2) was compared. Compared with group I, the value of SpO2 in the three time points of T1, T2, T3 in group II was higher; the difference was statistically significant (P0.05); the VAS score was compared with the group I, and the group II was compared at the point of time point. The difference was not statistically significant (P0.05). Compared with group I, the VAS score of group II decreased (P0.05).MMSE comparison in T1, T2, and T3 points after operation. Compared with group I, there was no significant difference in the MMSE score of group II at T0 time point (P0.05). Comparison of the level of beta amyloid protein (A beta) in blood: compared with group I, there was no significant difference in the level of p- amyloid protein (Ap) in the blood of group II at the time point of To (P0.05). Compared with group I, the level of p- amyloid egg white (A beta) in the blood of T1, T2, T3 at all time points was lower, and the difference was statistically significant (P0.05); the self controlled analgesic pump Comparison of the times of self pressing every 12 hours: compared with group I, group II had more pressing times per day, and the difference was statistically significant (P0.05). Conclusion flurbiprofen and sufentanil had good analgesic effect for postoperative analgesia in elderly patients. It was better than sufentanil alone for postoperative analgesia. Flurbiprofen was used in combination with Fentanil. Koshufinta Ni used for postoperative analgesia in the elderly patients to some extent reduce the incidence of adverse reactions, but also to a certain extent, it can significantly reduce the incidence of postoperative cognitive dysfunction.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

【参考文献】