盐酸戊乙奎醚对老年患者术后精神功能的影响

Effects of Penehyclidine Application before Operation on Postoperative Mental Function in the Elder

目的观察不同剂量盐酸戊乙奎醚(长托宁)对老年人术后精神功能的影响。方法采用随机双盲对照实验。选择择期全麻下行腹腔镜胆囊切除手术老年患者120例。随机分为三组(每组40例),于入室麻醉前10 min,Ⅰ组(对照组)静注生理盐水1.0 ml;Ⅱ组静注长托宁0.5 mg;Ⅲ组静注长托宁1.0 mg。于术前1 d及术后72 h以简易智力状态量表(MMSE)行认知功能测定;气管导管拔除后观察病人1周精神功能状况,以ICU精神错乱评估法(CAM-ICU)行术后谵妄评估。结果三组气管导管拔除时间差异无统计学意义(P>0.05),术后72 hⅢ组MMSE评分为22.0±2.2,低于Ⅰ组和Ⅱ组(23.2±2.1,23.3±2.3,P<0.05),而Ⅱ组与对照组之间差异无统计学意义(P>0.05)。Ⅲ组术后精神障碍(谵妄)发生率35.0%,高于对照组(12.5%)和Ⅱ组(15.0%)(P<0.05)。结论长托宁增加到一定剂量,对老年患者术后精神功能有明显影响,增加术后谵妄的发生。

Objective To investigate the effects of different dose of penehyclidine application before operation on postoperative mental function in the elder.Methods 120 cases of old patients scheduled for laparoscope cholecystectomy operation under generalanesthesia,were randomly allocated into 3 groups（40 each）： group one（control group） was premedicated with sodium choride injection 1ml intravenous infusion 10 min before anesthesia,group two was premedicated with penehyclidine 0.5mg,and group three received penehyclidine 1mg as premedication by the same way.The mini-mental state examination（MMSE） was performed for congnitive test l day before and 72 h after the operation.The postoperative mental state changes or delirium was evaluated with confusion assessment method for ICU（CAM-ICU） performed within one week after extubation.Results There were no significant differences involving the time of tube withdrawing（P〉0.05）.The score of MMSE in group three was 22.0±2.2,lower than those in group one and group two（23.2±2.1,23.3±2.3,P〈0.05） at 72h after operation,whereas no significant differences between control group and group two（〉0.05）.The incidence of postoperative mental state changes（delirium） group three was 35.0%,higher than those in control（12.5%）and two group（15.0%）（P〈0.05）.Conclusion Application of different dose of penehyclidine adding to the degree before operation,provides significantly the danger of postoperative mental disfunction or postoperative delirium in the elder.