盐酸戊乙奎醚对老年患者术后认知功能的影响

Effect of Penehyclidine Hydrochloride on Postoperative Cognitive Function in Elderly Patients

目的观察应用不同剂量盐酸戊乙奎醚对老年患者肝胆手术后认知功能的影响。方法选择全麻下行胆囊切除手术老年患者34例,部分肝切除26例。按照盐酸戊乙奎醚剂量分低剂量组(A组0.004 mg/kg),中剂量组(B组0.008 mg/kg)和高剂量组(C组0.012 mg/kg)。结果①注药后20 min、30 min三组患者口干评分明显升高(P<0.05)。②术后均有认知功能障碍(POCD)的发生,A组发生率(5%)明显低于B组(15%)和C组(35%)。③三组患者术前MMSE评分差异无统计学意义;A组术后24 h和48 h MMSE评分下降,但差异无统计学意义;B组和C组24 h和48 h MMSE的评分明显下降,差异有统计学意义(P<0.05);A组和B组72 h的MMSE评分恢复至术前水平,C组患者的MMSE评分仍然低于术前水平,差异有统计学意义(P<0.05)。结论盐酸戊乙奎醚应用于老年患者手术时,可导致认知功能障碍的发生,发生率与剂量相关,高剂量组持续时间较长,提示老年患者低剂量应用相对安全,同时也可减少围术期唾液腺分泌。

Objective To observe the effects of different doses of Penehyclidine hydrochloride on early cognitive function in patients with general anesthesia in operation on liver. Methods The research choose general anesthesia in elderly patients with cholecystectomy operation in 34 cases, partial liver resection in 26 cases. In accordance with penehyclidine hydrochloride divided dose of low dose group （group A, 0.004 mg/kg）, the middle dose group （B group, 0.008 mg/kg） and high dose group （group C, 0.012 mg/kg）. Results 0）Note 20 min, 30 min three groups of patients with xerostomia score increased significantly after administration （P〈0.05）. ~The three groups after operation have cognitive dysfunction （POCD） occurs, the incidence rate of A group （5%） was significantly lower than that in B group （15%） and C group （35%）. @No significant differences of MMSE scores between three groups before operation. A group of postoperative 24 h and 48 h MMSE score decreased, but the difference was not statistically significant; B group and C group 24 h and 48 h MMSE were significantly decreased, the difference was btatistically significant （P〈0.05）; group A and group B 72 h MMSE recovered to the preoperative level, C MMSE score in group was still lower than the preoperative levels, the difference was statistically significant （P〈0.05）. Conclusion Use of penehyclidine hydrochloride in elderly patients during operation can cause cognitive dysfunction, and dose related incidence, high dose group of longer duration. That elderly patients with low dose with relatively safe, at the same time also can reduce the perioperative the secretion of the salivary glands.