酒石酸布托啡诺术后镇痛对老年创伤患者芬太尼用量及术后认知功能的影响

Effect of butorphanol tartrate postoperative analgesia on the dose of fentanyl in elderly trauma patients and postoperative cognitive function

目的观察酒石酸布托啡诺术后镇痛对老年创伤患者芬太尼用量及术后认知功能的影响。方法选取112例老年创伤手术患者,随机分为2组,每组56例。对照组用芬太尼术后镇痛,观察组用酒石酸布托啡诺复合芬太尼术后镇痛。用VAS评分法对两组患者术后6、24、48 h的镇痛效果进行评估,同时采用Ramsay镇静评分。两组患者术前1 d(T0)测定认知功能基础值,术后在30 min(T1)、1 h(T2)、2 h(T3)、12 h(T4)、24 h(T5)5个时间点再进行认知功能测定,MMSE满分为30分,术后低于术前2分以上且总分≤24分认定发生术后认知功能障碍。观察两组患者芬太尼的用量及自控给药次数、不良反应发生情况。结果观察组术后6 h、24 h时VAS评分明显低于对照组(P<0.05),术后48 h时,两组患者VAS评分比较差异无统计学意义。观察组、对照组的术后镇静满意率分别为94.64%、80.36%,观察组镇静满意度明显高于对照组(P<0.05)。观察组、对照组在术后分别有2例、9例发生术后认知功能障碍,两组比较差异有统计学意义(P<0.05),且观察组在T1、T2时,4项认知功能测试评分均明显高于对照组(P<0.05)。观察组、对照组的芬太尼用量分别为(564.3±67.5)μg、(867.4±120.2)μg,自控给药次数分别为(6.9±3.1)次、(14.2±4.8)次,观察组均明显低于对照组(P<0.05)。观察组、对照组分别有6例(10.71%)、16例(28.57%)发生不良反应,观察组明显低于对照组(P<0.05)。结论对老年创伤手术患者采用酒石酸托啡诺术后镇痛可减少芬太尼用量,提高镇痛及镇静效果,而且可有效降低术后认知功能的发生及不良反应发生率。

Objective To observe and compare the postoperative analgesic effect of butorphanol tartrate on the dose of fentanyl in elderly trauma patients and postoperative cognitive function. Methods 112 cases of elderly patients with trauma surgery were randomly divided into 2 groups. Patients in control group（ n = 56 ）were given fentanyl analgesia,patients in observation group（ n = 56）were given butorphanol tartrate combined with fentanyl analgesia. VAS score was used to assess the analgesia at 6 h,24 h and 48 h after operation,while Ramsay sedation score was used to assess the effect of sedation. The baseline cognitive function was recoded at 1 d before surgery （TO） ,30 min（ T1 ） , 1 h（ T2 ） , 2h（ T3 ） , 12 h（T4） ,24 h（ T5 ）after surgery. The maximum score of MMSE was 30 points, the postoperative cognitive dysfunction was identified when postoperative score was at least 2 points less than that of preoperative score and the total score ≤24 points. The fentanyl dosage, frequency of self-controlled medication, the incidence of adverse reactions were observed. Results The VAS score of observation group was significantly lower than that of control group （ P 〈 0. 05 ） at 6 h and 24 h after operation. The postoperative sedation satisfaction rate of observation group and control group were 94. 64% and 80. 36% , there was significant difference between the two groups （ P 〈 0. 05 ）. There were 2 cases and 9 cases with postoperative cognitive dysfunction in observation group and control group, there was significant difference between the two groups（ P 〈 0. 05 ） , and the scores of the four tests of cognitive function in observation group were significantly higher than those of control group at T1 and T2 （ P 〈 0. 05 ）. The Fentanyl dosages of observation group and control group were（ 564. 3 ± 67.5 ） μg and（ 867.4 ± 120. 2 ）g, the frequency of self-controlled medication of were （ 6. 9 ± 3. 1 ） and （ 14. 2 ± 4. 8 ） , there were significant differences between the two groups （ P 〈 0. 05 ）. There were 6 cases （ 10. 71% ）and 16 cases （28.57%）of adverse reactions in observation group and control group, there was signifi- cant difference between the two groups （ P 〈 0. 05 ）. Conclusion Butorphanol tartrate can reduce the dose of fentanyl in elderly patients with trauma surgery, improve the analgesic and sedative effects, and can effectively reduce the incidence of postoperative cognitive function and adverse reactions.