地佐辛预防瑞芬太尼复合麻醉下膝关节置换术老年病人术后认知功能障碍的效果

Efficacy of dezocine for prevention of postoperative cognitive dysfunction in elderly patients undergoing total knee arthroplasty under remifentanil-based anesthesia

目的 评价地佐辛预防瑞芬太尼复合麻醉下膝关节置换术老年病人术后认知功能障碍（POCD）的效果.方法 择期全麻下行单侧膝关节置换术老年病人68例,性别不限,年龄65～85岁,体重48 ～ 78 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组（n=34）：对照组（C组）和地佐辛组（D组）.两组全麻诱导气管插管后行机械通气,麻醉维持：静脉输注异丙酚0.05 ～ 0.06mg＆#183; kg-1＆#183;min-1和瑞芬太尼0.05～0.10 μg＆#183;kg-1＆#183;min-1,间断静脉注射维库溴铵0.04 mg/kg.切皮前30 min时D组静脉注射地佐辛0.1 mg/kg.分别于术前1 d（T0）、术后1 d（T1）、3 d（T2）、5d（T3）、7 d（T4）时采集中心静脉血样,测定血清皮质醇（Cor）、神经元特异性烯醇化酶（NSE）和S-100β蛋白的浓度;分别于术前、术后5、7d时进行简明心智评分测验法（MMSE）评分,并记录POCD的发生情况.结果 与T0时比较,2组T1-3时血清Cor、NSE和S-100β蛋白的浓度升高,术后5、7d时MMSE评分降低（P＜0.05）;与C组比较,D组T1-4时血清Cor、NSE和S-100β蛋白的浓度降低,术后5、7d时MMSE评分升高,POCD发生率降低（P＜0.05）.结论 切皮前30 min静脉注射地佐辛0.1 mg/kg可预防瑞芬太尼复合麻醉下膝关节置换术老年病人POCD发生.

Objective To evaluate the efficacy of dezocine for prevention of postoperative cognitive dysfunction （POCD） in elderly patients undergoing total knee arthroplasty under remifentanil-based anesthesia.Methods Sixty-eight patients of both sexes, aged 65-85 yr, weighing 48-78 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective unilateral total knee arthroplasty under general anesthesia, were randomly divided into 2 groups （n =34 each） using a random number table： control group （group C） and dezocine group （group D）.After induction of anesthesia, the patients were tracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 0.05-0.06 mg ＆#183; kg-1 ＆#183; min-1 and remifentanil 0.05-0.10 μg ＆#183; kg-1 ＆#183; min-1, and intermittent iv boluses of vecuronium 0.04 mg/kg.Dezocine 0.1 mg/kg was injected intravenously at 30 min before skin incision in group D.At 1 day before operation （T0） , and 1, 3, 5, 7 days after operation （T1 , T2, T3 , T4） , the blood samples from the central vein were collected for determination of serum cortisol （Cor）, neuron specific enolase （NSE） and S-100β protein concentrations.Before operation, and 5 and 7 days after operation, the patients＆#39; cognitive function was assessed using Mini-Mental State Examination, and the occurrence of POCD was recorded.Results Compared with the baseline value at T0, the serum Cor, NSE and S-100β protein concentrations were significantly increased at T1-3, and MMSE scores were decreased at T3,4 in the two groups.Compared with group C, the serum Cot, NSE and S-100β protein concentrations were significantly decreased at T1-4, and Mini-Mental State Examination scores were increased at 5 and 7 days after operation, and the incidence of POCD was decreased in group D.Conclusion Dezocine 0.1 mg/kg intravenously injected at 30 min before skin incision can prevent the occurrence of POCD in elderly patients undergoing total knee arthroplasty under remifentanil-based anesthesia.