布托啡诺超前镇痛对老年人全髋关节置换术后早期认知功能的影响

Effects of Butorphanol in Preemptive Analgesia on Cognitive Dysfunction Early after Total Hip Arthroplasty in Elderly Patients

目的观察术前应用布托啡诺对老年患者腰硬联合麻醉下全髋关节置换术后早期认知功能的影响。方法选择腰硬联合麻醉下行全髋关节置换术年龄>70岁且麻醉效果确切的老年患者60例,随机均分为布托啡诺组和对照组。布托啡诺组在麻醉前10 min静脉注射布托啡诺0.02mg/kg,对照组给予等容积的生理盐水模拟。待麻醉平面出现后,予以丙泊酚1-2mg/(kg h)持续静脉。术中应用AS3多功能监测仪连续监测血压、心率、心电图、血氧饱和度。并分别于术前1d、术后3d、术后7 d由本院同一心理医生采用神经心理学测试技术简易智力状态检查(MMSE)评定患者认知功能。结果布托啡诺组术后认知功能障碍(POCD)发生率为30.0%,对照组为33.3%,两组间差异无统计学意义。结论术前静脉注射布托啡诺0.02mg/kg行超前镇痛对老年人全髋关节置换术后认知功能障碍(POCD)发生率无显著影响。

Objective To study the effects of Butorphanol in preemptive analgesia on cognitive dysfunction early after total hip arthroplasty in elderly patients.Methods 60 patients older than 70 years under combined spinal and epidural anesthesia for total hip arthroplasty were divided randomly into two groups： butorphanol group and control group.The former were given 0.02mg/kg butorphanol 10 min before anesthesia,and the latter were given the samevolume saline instead.During operation,sedation was maintained with 1-2mg/（kg h） propofol intravenous injection.All patients were tested with milimental state examination by the same doctor,preoperatively,3d postoperatively and7d postoperatively.Results The incidences of POCD were 30% and 33% among butorphanol group and control group,there was no significant difference between the two groups.Conclusion Preoperative administration of butorphanol（0.02mg/kg） would not influence the incidence of cognitive dysfunction early after total hip arthroplasty in elderly patients.