盐酸氢吗啡酮术后镇痛对老年患者术后认知功能和炎性因子的影响

Effect of postoperative analgesia with hydromorphone on postoperative cognitive function and inflammatory factors in elderly patients

目的:观察盐酸氢吗啡酮(HM)用于老年患者腹腔镜胆囊切除术术后镇痛对认知功能、炎性因子的影响。方法:选择62例老年择期住院患者,随机分为舒芬太尼组(SF组)和盐酸氢吗啡酮组(HM组)。两组患者全身麻醉使用相同的麻醉药物,SF组使用舒芬太尼,HM组使用氢吗啡酮进行术后镇痛。观察两组患者在术后不同时间点的简易精神状态评价量表(MMSE)的评分和炎性因子水平以及术后镇痛不良反应、镇痛不全补救的发生率。结果:两组患者术前MMSE评分和炎性因子水平差异无统计学意义(P>0.05)。在术后不同时间点,HM组MMSE评分均高于SF组,炎性因子水平低于SF组,两组比较差异具有统计学意义(P<0.05)。不良反应方面与SF组比较,恶心、呕吐、嗜睡、镇痛不全在HM组发生率低,两组比较差异有统计学意义(P<0.05)。结论:HM用于老年患者腹腔镜胆囊切除术术后镇痛能改善患者的术后认知功能、降低炎性因子水平且不良反应发生率低,值得临床推广。

Objective To observe the effects of hydromorphone(HM) on cognitive function,inflammatory factors and adverse reactions in elderly patients after laparoscopic cholecystectomy.Method 62 elderly patients were selected for elective hospitalization.They were randomly divided into sufentanil group(SF group) and hydromorphone group(HM group).The two groups of patients underwent general anesthesia with the same anesthetic drugs,Sufentanil was used in the SF group,and hydromorphone was used in the HM group for postoperative analgesia.The scores of the Mini-Mental State Assessment Scale(MMSE) and the levels of inflammatory factors and the incidence of postoperative analgesic adverse reactions and analgesic remedy were observed at different time points in the two groups.Results There was no difference in preoperative MMSE scores and inflammatory factors between the two groups(P>0.05).The MMSE scores in the HM group were higher than those in the SF group at different time points,and the inflammatory factors were lower than the SF group, the difference was statistically significant(P<0.05),the incidence of adverse reactions compared with SF group,Nausea and vomiting,lethargy,analgesic remedy rate was low in HM group,the difference was statistically significant(P<0.05).Conclusion HM for postoperative analgesia after laparoscopic cholecystectomy in elderly patients can improve postoperative cognitive function,reduce inflammatory factor levels and have a low incidence of adverse reactions,which is worthy of clinical promotion.