不同术后镇痛方式对腹腔镜胆囊切除术患者术后谵妄的影响

Effect of Different Analgesia Methods on the Postoperative Delirium in Patients undergoing Laparoscopic Cholecystectomy

目的评价不同镇痛方式对腹腔镜胆囊切除术患者术后谵妄的影响.方法经腹腔镜胆囊切除手术患者300例,随机分为D组(n=100):地佐辛5 mg静注;P组(n=100):帕瑞昔布纳40 mg静注;C组(n=100):生理盐水5 mL静注.D、P、C组均在手术结束前15 min给药.记录麻醉恢复情况;用视觉模拟评分法(VAS评分)分别对3组术后4、12、24 h进行疼痛评分;用谵妄评定法评估术后4、4～12、12～24 h内发生谵妄的情况.结果与C组比较,D组、P组麻醉恢复期睁眼时间、拔管时间、清醒时间延长,出现呛咳/躁动、使用硝酸甘油的患者例数少,且术后发生谵妄的患者例数少(P<0.05).结论经腹腔镜胆囊切除术中单次用地佐辛5 mg或帕瑞昔布纳40 mg具有良好的术后镇痛效果,且发生术后谵妄的机率低.

Objective To investigate the effect of different analgesia methods on the postoperative delirium in patients undergoing laparoscopic cholecystectomy.Methods 300 patients undergoing laparoscopic cholecystectomy were randomly divided into three groups：group D（n=100） received Dezocine 5 mg;group P（n=100） received Parecoxib Na 40 mg and group C（n=100） received Physiological saline 5 mL.Dezocine,Parecoxib Na and Physiological saline were used when the procedure was finished before 15 minutes.The time of anesthesia recovery were recorded.The effect of analgesia was assessed by visual analog scale（VAS） and delirium were recorded within 4,12,24 hours postoperatively.Results The awakening time,extubation time and consciousness time were significantly shortened,The amount of nitroglycerin were significantly lower,Bucking and/or restlessness during recovery were lower,the incidence of postoperative delirium was significantly lower in group D and P than in group C（P〈0.05）.Conclusion Dezocine and Parecoxib Na have good postoperative analgesic effect on patients undergoing laparoscopic cholecystectomy,and may decrease the incidence of postoperative delirium.