不同术后镇痛方法对老年患者认知功能的影响

Cognitive Effects after Epidural vs Vein Postoperative Analgesia in Older Adults

目的探讨不同的术后镇痛方法对老年患者认知功能的影响的差异性，为提高老年患者术后生活质量，减轻认知功能扰乱提供依据。方法选择行腹部手术患者64例，年龄60岁以上术前无明显认知障碍，不合并脑血管疾患，无呼吸功能障碍，无肝肾功能障碍。实施连续硬膜外麻醉，随机分为2组，每组32例。经硬膜外自控镇痛组（PCEA组）：术后先给0．25％罗哌卡因6ml＋吗啡1～1．5mg＋氟哌利多1．25mg负荷镇痛剂量，尔后用100m10．25％罗哌卡因＋吗啡5mg＋氟哌利多2．5mg作术后2dPCEA。持续注入速率2．0ml／h，PCEA量1．0ml／次，锁定时间为15min。经外周静脉自控镇痛组（PCIA组）：吗啡1．0mg／ml＋氟哌利多0．2mg／ml，负荷镇痛剂量5．0ml，PCIA量1．0ml／次，持续注入速率1．0ml／h，锁定时间为15min。分别于术前、术后1d和3d进行认知功能测定。结果两组患者术后自控镇痛，其疼痛视觉评分无差异，均达到满意效果。术后1dPCIA组有近半数患者认知功能测试异常，与PCEA组比较：P〈0．01，PCIA术后镇痛对认知功能改变更加明显。由此说明，术后镇痛单从认知功能改变考量，PCEA较PCIA优越。结论PCIA与PCEA应用于老年患者下腹部手术术后镇痛，均能达到满意的术后镇痛，但PCIA影响术后认知功能较PCEA明显。因此，术后镇痛选用PCEA较PCIA优越。

Objective To observe cognitive effects after epidural vs vein postoperative analgesia in older adults. Methods 64 patients,age t〉 60 years old,ASA grade Ⅰ-Ⅱ , scheduled for abdominal surgery by epidural anaesthesia were divided randomly into two groups：patient controlled epidural analgesia （PCEA）group （group PCEA, n = 32 ） ：commenced with a loading dose of 6 ml（0. 25% ropivacaine with morphine 1.0 - 1.5 mg and droperidol 1.25 mg） , and continuous epidurally infusion of 0. 25% ropivacaine（ 100 ml with morphine 5 mg and droperidol 2. 5 mg） ,the PCEA pump was set up with 1 ml bolus with a 15 min lockout interval and a back- ground infusion at 2.0 ml/h. patient controlled intravenous analgesia（ PC IA） group（ group PCIA, n = 32 ） ： receiving continuous intravenous analgesia with 0. 1% morphine （with droperidol 0. 2 mg/ml ）, commenced with a loading dose of 5.0 ml,the PCIA pump was set up with 1 ml bolus with a 15 min lockout interval and a background infusion at. 1.0 ml/h for postoperative analgesia. Postoperative analgesic effect was assessed by visual analog scales（ VAS,0 - 100）. Results the outcome of cognitive function at the before operation, 1 d and 3 d after operation. Results Both groups were equally effective in postoperative analgesia, about 50% patients had impact of the cognitive function in the group PCIA at 1 d after operation, Compared with the group PCEA, the im- pact of the cognitive function of group PCIA were more significantly. Conclusion PCEA is more suitable for the postoperative analgesia in the elderly.