术毕静注新斯的明对老年患者术后早期认知功能障碍发病率的影响

The Effect of Postoperative Intravenous Neostigmine Administration Antagonizing Residual Neuromuscular Blockade on Early Postoperative Cognitive Dysfunction Morbidity in Elderly Patients

为评价术毕静注新斯的明拮抗肌松残余效应时对老年患者术后早期认知功能障碍(POCD)发病率的影响,回顾性分析笔者所在医院2007年6月~2017年6月65岁以上在气管内插管全凭静脉麻醉下行髋关节置换术的老年患者1 372例,根据术毕是否静注新斯的明拮抗肌松残余效应,将其分为新斯的明组(n=597)及非新斯的明组(n=775)。术毕待开始有自主呼吸或四个成串刺激(TOF)出现2个反应(T_1和T_2)时,静脉注射新斯的明1mg^2mg拮抗肌松残余效应或不用新斯的明待肌力自然恢复。统计在麻醉恢复室(PACU)内停留时间、术后阿托品用量及POCD的发病率等指标。结果发现术后阿托品用量,新斯的明组明显高于非新斯的明组,在PACU内停留时间及早期POCD发病率新斯的明组明显短(低)于非新斯的明组(P<0.05)。综上所述,术毕静注新斯的明拮抗肌松残余效应时可能降低行髋关节置换术的老年患者早期POCD的发病率。

To evaluate the effect of postoperative intravenous Neostigmine administration antagonizing residual neuromuscular blockade on early postoperative cognitive dysfunction( POCD) morbidity in elderly patients,ASA Ⅰ or Ⅱ,over 65 years old patients received hip replacement surgery under total intravenous anesthesia( TIVA) with intubation from June 2007 to June 2017 were analyzed. A total of 1372 patient's data( male: 477,female: 895) are collected,the patients were divided into two groups depending on whether the patient received postoperative intravenous neostigmine administration to antagonizing residual neuromuscular blockade: neostigmine group( n = 597) and non-neostigmine group( n = 775). Neostigmine( 1 mg ~ 2 mg) was intravenously administered when patient started spontaneous breathing or two reactions of TOF( T_1 and T_2) can be observed to antagonizing residual neuromuscular blockade or not administrated neostigmine for naturally recovery. Post-anesthesia care unit(PACU) stay duration,postoperative usage of atropine,morbidity of POCD,et al were analysed. The results were that the postoperative atropin usage was significantly high in neostigmine group compared to non-neostigmine group. While the duration of PACU stay and morbidity of POCD in neostigmine group was significantly shorter and lower than non-neostigmine group( P<0.05).In summary,Postoperative intravenous neostigmine administration antagonizing residual neuromuscular blockade can significantly reduce the morbidity of POCD.