麻醉前应用戊乙奎醚对老年人术后早期精神功能的影响

Effects of penehyclidine application before operation on early postoperative mental function in elder

目的:探讨麻醉前应用戊乙奎醚对老年人术后早期精神功能的影响。方法:选择择期全麻下行腹部及股骨手术老年病人120例。随机分为对照组、东莨菪碱组和戊乙奎醚组,每组40例。对照组病人不用任何术前药,麻醉前30 min东莨菪碱组肌内注射东莨菩碱0．3 mg,戊乙奎醚组肌内注射戊乙奎醚1 mg。于术前1 d及术后48 h以简易智力状态量表(MMSE)行认知功能测定:气管导管拔除后10 min以ICU精神错乱评估法(CAM-ICU)行术后谵妄评估。结果:3组气管拔管时间差异无显著意义(P＞0．05),术后48 h东莨菪碱组MMSE评分22．0±s 2．3,低于对照组和戊乙奎醚组(23．1±2．0,23．4±2．4,P＜0．05),而戊乙奎醚组和对照组间无明显差异(P＞0．05)。东莨菪碱组谵妄发生率32％,高于对照组与戊乙奎醚组(10％,12％,P＜0．05)。结论:使用戊乙奎醚代替传统的抗胆碱药作为术前用药,有利于减少老年人术后早期认知功能障碍的发生。

AIM ： To investigate the effects of penehyclidine application before operation on early postoperative mental function in the elder. METHODS： One hundred and twenty old patients scheduled for abdominal or femur operation under general anesthesia, were randomly assigned into 3 groups （40 each） ： control group, scopolamine group, and penehyclidine group. Control group was unpremedicated, scopolamine group was premedicated with scopolamin 0.3 mg intramuscular injection 30 min before anesthesia, and penehyclidine group received penehyclidine 1 mg as premedication by the same way. The mini-mental state examination （MMSE） was performed for congnitive test 1 d before and 48 h after the operation. The postoperative delirium was evaluated with confusion assessment method for ICU （CAM-ICU） performed 10 min after extubation. RESULTS： There were no significant differences involsing the time of tube withdrawing （P 〉 0.05）. The score of MMSE in scopolamine group was 22.0±s 2.3, lover than those in control and penehyclidine group （23.1 ± 2.0, 23.4 ± 2.4, P 〈 0.05） at 48 h after operation, whereas no significant difference between control group and penehyclidine group （P 〉 0.05）. The incidence of postoperative delirium in scopolamine group was 32 %, higher than those in control and penehyclidine group （10 %, 12 %, P 〈 0.05）. CONCLUSION： Application of penehyclidine before operation provides advantage of reducing postoperative mental disfunction in the elder and it may well substitute for conventional receptor-M antagonists as premedica-tion.