羟考酮术后镇痛对老年患者腹腔镜胆囊切除术后早期认知功能的影响

Effects of postoperative analgesia with oxycodone on postoperative cognitive dysfunction in aged patients undergoing laparascopic cholecystectomy

目的观察羟考酮术后镇痛对老年患者腹腔镜手术后早期认知功能的影响。方法选择在全麻下接受择期腹腔镜胆囊切除手术的老年患者120例,男57例,女63例,年龄70～80岁,ASAⅠ或Ⅱ级,随机均分为三组:芬太尼组、舒芬太尼组和羟考酮组,每组40例,术后分别使用芬太尼2.0mg、舒芬太尼150μg和羟考酮40mg行PCIA。采用VAS疼痛评分法评估术后48h内镇痛效果,记录患者术后48h内芬太尼、舒芬太尼和羟考酮使用量以及恶心呕吐及皮肤瘙痒等不良反应的发生情况,术后7d采用简易精神状态量表(MMSE)评价患者认知功能,判断是否发生POCD。结果术后48h内三组不同时点VAS评分差异无统计学意义。羟考酮组术后恶心呕吐和瘙痒发生率明显低于芬太尼组和舒芬太尼组(P<0.05)。芬太尼组和舒芬太尼组术后镇痛药物用量与术后7dMMSE评分呈负相关关系(P<0.01)。芬太尼组、舒芬太尼组和羟考酮组术后7dPOCD分别有15例(37.5%)、13例(32.5%)和7例(17.5%),羟考酮组POCD发生率明显低于芬太尼组和舒芬太尼组(P<0.05)。结论与芬太尼和舒芬太尼比较,羟考酮用于老年患者术后镇痛可降低POCD的发生率,减少恶心呕吐和瘙痒的发生。

Ojective To investigate effects of postoperative analgesia with oxycodone on postoperative cognitive dysfunction in aged patients undergoing laparascopic cholecystectomy. Methods One hundred and twenty patients scheduled for laparascopic cholecystectomy with general anesthesia, 57 males and 63 females, aged 70-80 years, ASA physical status Ⅰ or Ⅱ, were enrolled in the present study. The patients were divided randomly into fentanyl group, sufentanil group and oxycodone group （n=40） according to postoperative analgesia. Visual analog scale （VAS） scores, nausea or vomiting, itching and analgesics consumption of all patients were recorded in the postoperative 48 h. Neuropsychological testing was performed with mini-mental state examination （MMSE） on the 7th postoperative day. Results There was no statistical significance between the three groups in VAS scores at different time points in the postoperative 48 h. The incidence of itching, nausea or vomiting in oxycodone group was lower than that in fentanyl group and sufentanil group （P〈0.05）. Analgesics consumption in fentanyl group and sufentanil group exhibited a negative correlation with MMSE scores on the 7th postoperative day （P〈0.01）. There was no correlation between analgesics consumption and MMSE scores in oxycodone group. The incidence of POCD was 15 （37.5%） in fentanyl group, 13 （32.5%） in sufentanil group and 7 （17.5%） in oxycodone group. The incidence of POCD in oxycodone group was lower than those in fentanyl group and sufentanil group （P〈0.05）. Conclusion Oxycodone, replacing fentanyl or sufentanil, can be used for postoperative analgesia and reduce the incidence of POCD with less nausea, vomiting and itching in aged patients.