氢吗啡酮超前镇痛对老年患者术后认知功能及炎性细胞因子的影响

Influence of preemptive analgesia with Hydromorphone Hydrochloride on postoperative cognitive function and inflammation response in the elderly patients

目的：探讨氢吗啡酮超前镇痛对老年全髋关节置换术后认知功能及炎性细胞因子的影响。方法：90例ASAⅠ～Ⅱ级择期行全髋关节置换术的老年患者，采用随机数字表法，将患者随机分为氢吗啡酮组（H组）和对照组（C组）（n=45）。全麻诱导前，H组静脉注射氢吗啡酮2mg，C组给予等容量生理盐水。术后行PCIA，药物为舒芬太尼，镇痛效果不佳时静注地佐辛0．1mg／kg。分别于术前（T0）、术毕（T1）、术后6h（T2）、术后24h（L）和术后3d（T4）检测血清C反应蛋白、肿瘤坏死因子、白介素-6浓度；并采用简易精神状态量表评价认知功能。记录术后舒芬太尼用量和地佐辛补救用药情况。结果：与C组比较，H组术后血清C反应蛋白、肿瘤坏死因子、白介素-6浓度降低，舒芬太尼用量和地佐辛补救用药率均降低，认知功能障碍发生率降低（P〈0．05）。结论：氢吗啡酮2mg超前镇痛可降低老年患者术后认知功能障碍的发生。

Objective To investigate the influence of preemptive analgesia with Hydr- omorphone Hy- drochloride on postoperative cognitive function and inflammation cytokines in the elderly patients. Methods Ninety ASA I or 11 elder patients were randomly divided in control group （C）and Hydromorphone Hydrochloride group（H） with 45 cases each. Hydromorphone Hydrochloride 2 mg was injected iv before induction of anesthesia in group H. Observed plasma concentrations of the CRP, TNF-ct and IL-6 at different time. Cognitive function was assessed by minimental state examination. Results Plasma the CRP, TNF-a and IL-6 concentrations were lower and MMSE scales were higher in group H than in group C. Conclusion Preemptive analgesia with Hy- dromorphone Hydrochloride 2 mg can reduce the incidence of postoperative cognitive dysfunction in the elderly patients.