吗啡超前镇痛联合低位硬膜外麻醉对老年下肢骨科手术的影响

Effect of preemptive analgesia with Morphine combined low epidural anesthesia in lower limb orthopedic surgery for the elderly

目的探讨吗啡超前镇痛联合低位硬膜外麻醉对老年下肢骨科手术的影响。方法选取2020年3~9月于康美医院行下肢骨科手术的60例老年患者为研究对象。按照随机数字表法分为观察组和对照组,每组各30例。两组患者术前常规禁食、水8 h,术前均不使用镇痛药。患者入室后均由同一麻醉师操作,给予硬膜外麻醉,麻醉前10 min对照组给予生理盐水5 mL/(kg·h)静脉注射;观察组给予吗啡1~1.5 mg(加生理盐水5 mL)静脉注射。比较两组患者警觉/镇静评分(OAA/S)、视觉模拟评分法(VAS)、认知功能[简易智能精神状态检查量表(MMSE)]、镇痛持续时间及不良反应发生情况。结果两组术后12、24、48 h的OAA/S、VAS评分均低于术毕,差异有统计学意义(P<0.05);两组各时间点的OAA/S评分比较,差异无统计学意义(P>0.05);观察组术毕及术后12、24 h的VAS评分低于对照组,差异有统计学意义(P<0.05);对照组术后1、3 d的MMSE评分低于术前,差异有统计学意义(P<0.05);观察组各时间点的MMSE评分比较,差异无统计学意义(P>0.05);观察组术后1、3 d的MMSE评分高于对照组,差异有统计学意义(P<0.05);观察组镇痛持续时间长于对照组,差异有统计学意义(P<0.05);两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论吗啡超前镇痛联合低位硬膜外麻醉对老年下肢骨科手术患者镇静效果好,镇痛持续时间长,可降低患者术后认知功能障碍的发生率。

Objective To explore the effect of preemptive analgesia with Morphine combined low epidural anesthesia in lower limb orthopedic surgery for the elderly.Methods A total of 60 elderly patients who underwent lower limb orthopedic surgery in Kangmei Hospital from March to September 2020 were selected as the research objects.According to the random number table method,they were divided into observation group and control group,with 30 cases in each group.Two groups of patients were routinely fasted and watered for 8 hours before operation,and no analgesics were used before operation.All patients were operated by the same anesthesiologist and given epidural anesthesia,and the control group was given 5 mL/(kg·h)saline intravenously 10 min before anesthesia.The observation group was given Morphine 1-1.5 mg(plus normal saline 5 mL)by intravenous injection.The alertness/sedation score(OAA/S),visual analogue scale(VAS),cognitive function(mini-mentalstateexa mination[MMSE]),analgesic duration and adverse reactions were compared between the two groups.Results OAA/S and VAS scores at 12,24 and 48 h after operation were lower than those at the end of operation,and the differences were statistically significant(P<0.05).There was no significant difference in OAA/S scores between the two groups at each time point(P>0.05).The VAS scores of the observation group at the end of operation and at 12 and 24 hours after operation were lower than those of the control group,and the differences were statistically significant(P<0.05).The MMSE scores of the control group at 1 and 3 days after operation were lower than those before operation,and the differences were statistically significant(P<0.05).There was no significant difference in MMSE scores at each time point in the observation group(P>0.05).The MMSE scores of the observation group at 1 and 3 days after operation were higher than those of the control group,the differencse were statistically significant(P<0.05).The analgesic duration of the observation group was longer than that of the control group,the difference was statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Preemptive analgesia with Morphine combined with low epidural anesthesia can achieve good sedative effects on elderly patients undergoing lower limb orthopedic surgery,and the analgesia lasts for a long time.Meanwhile,it can reduce the incidence of postoperative cognitive dysfunction.