肋间神经阻滞复合氢吗啡酮静脉镇痛对老年患者术后认知功能及镇痛的影响

发布时间：2018-02-09 18:30

本文关键词： 氢吗啡酮镇痛输注静脉内肋间神经阻滞术后认知功能障碍开胸手术老年人　出处：《重庆医学》2017年01期 　论文类型：期刊论文

【摘要】：目的探讨单纯肋间神经阻滞与肋间神经阻滞复合氢吗啡酮静脉镇痛对老年开胸手术术后认知功能及镇痛的影响。方法选择96例ASAⅠ~Ⅱ级择期行开胸手术的老年患者,采用随机数字表法,分为肋间神经阻滞(A组),肋间神经阻滞复合氢吗啡酮静脉镇痛(B组)和氢吗啡酮静脉镇痛(C组),每组32例患者。术后行经静脉自控镇痛,药物为舒芬太尼,镇痛效果不佳时静脉注射地佐辛0.1mg/kg。记录3组患者术后2、6、24、48h平均动脉血压(MAP),心率(HR),呼吸频率(RR),简易智力状态检查量表(MMSE)评分及视觉模拟评分法(VAS)评分。结果 B组术后MMSE评分高于A组和C组,VAS评分低于A组和C组,差异均有统计学意义(P0.05)。B组术后MAP、HR比A组和C组更平稳,差异有统计学意义(P0.05)。C组比A组和B组RR更快、幅度小,差异有统计学意义(P0.05)。结论肋间神经阻滞复合氢吗啡酮静脉镇痛在老年胸外科手术后能取得良好的术后镇痛效果,术后血流动力学平稳,术后早期认知功能障碍的发生率降低。
[Abstract]:Objective to investigate the effects of intercostal nerve block and intercostal nerve block combined with hydromorphone on cognitive function and analgesia after thoracotomy in elderly patients. The patients were randomly divided into intercostal nerve block group A, intercostal nerve block combined with hydromorphine ketone intravenous analgesia group B) and hydromorphine ketone intravenous analgesia group C with 32 patients in each group. Postoperative patient-controlled intravenous analgesia was performed with sufentanil. When analgesia effect was not good, dizosin was injected intravenously with dizosin 0.1 mg / kg. The mean arterial blood pressure (MAPP), heart rate (HRT), respiratory frequency (RRN), MMSE score and visual analogue score were recorded in group B. The MMSE score of group A and group C was higher than that of group A and C, and the scores of group A and group C were lower than those of group A. The differences were statistically significant. The MAPHR of group B was more stable than that of group A and group C. the difference was statistically significant. The RR of group P0.05 was faster and smaller than that of group B. Conclusion intravenous analgesia with intercostal nerve block combined with hydromorphone can achieve good postoperative analgesia effect after thoracic surgery, hemodynamics is stable, and the incidence of early postoperative cognitive dysfunction is reduced.
【作者单位】：承德医学院附属医院麻醉科;黑龙江省大庆市第五医院麻醉一科;
【基金】：河北省承德市科学技术研究与发展计划项目(20157042)
【分类号】：R614

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