电针超前镇痛对老年患者术后认知功能的影响

Effect of preemptive analgesia of electroacupuncture on postoperative cognitive function in elderly patients with abdominal surgery

目的探讨电针超前镇痛对老年腹部手术患者术后认知功能的影响。方法将127例开腹大手术老年患者按随机数字表法分为观察组63例和对照组64例。观察组及对照组分别行电针超前镇痛及常规镇痛。采用视觉模拟评分法（VAS）、简易智力状态检查法（MMSE）比较两组疼痛和认知功能；同时比较两组术后芬太尼的使用量及不良反应发生率。结果对照组排除4例患者（拒绝随访，提前拔除镇痛泵），观察组排除3例患者（拒绝随访及失访），两组各60例患者完成研究。观察组术后6h的疼痛评分为（1．86±0．62）分，低于对照组的（4．03±0．48）分，差异有统计学意义（t=3．67，P〈0．05）；观察组术后24h认知功能评分为（25．42±0．63）分，高于对照组的（21．77±0．50）分，差异有统计学意义（t=3．54，P〈0．05）；观察组术后镇痛的芬太尼用量为（597．94±82．41）μg，低于对照组的（826．47±113．28）μg，差异有统计学意义（t=5．42，P〈0．01）；观察组认知功能障碍（POCD）发生率为20．00％，低于对照组的38．33％，差异有统计学意义（X^2=3．03，P〈0．05）。结论应用电针超前镇痛于老年患者术后疼痛管理，可以降低老年患者术后的疼痛及改善POCD。

Objective To investigate the effect of preemptive analgesia on postoperative cognitive function in elderly patients with abdominal surgery. Methods Totals of 127 cases of elderly patients with open major surgery were randomly divided into two groups： the experimental group （63 cases） and the control group （64 cases）. The patients underwent preemptive analgesia in the experimental group, while the control group underwent conventional analgesia. VAS and MMSE were used to compare their pain and cognitive function between two groups, and dosages of fentanyl and adverse reactions were also observed. Results There were finally 60 cases in each group who had finished the study. The pain score was （ 1. 86±0. 62 ） in the experimental group and （4.03±0.48 ） in the control group six hours after operation, with statistically significant difference （ t = 3.67, P 〈 0.0）. The score of cognitive function was （25.42 ± 0.63 ） in the experimental group and （21.77± 0.50） in the control group 24 hours after operation, and the difference was statistically significant （t = 3.54, P 〈 0.05 ）. The dosages of fentanyl was （597.94±82.41 ） μg in the experimental group and （ 826.47± 113.28 ） μgin the control group, with statistically significant difference （ t = 5.42, P 〈 0.01 ）. The incidence of POCD was 20.00% in the experimental group and 38.33% in the control group, and the difference was statistically significant （X^2 = 3.03,P 〈 0.05）. Conclusions Preemptive analgesia of electroacupunctnreon elderly patients with abdominal surgery can significantly reduce their postoperative pain and improve cognitive dysfunction.