地佐辛与芬太尼静脉镇痛对老年患者术后认知功能的影响(1)
[摘要] 目的 探讨地佐辛与芬太尼静脉镇痛对老年患者术后认知功能的影响。 方法 选择2014年5月～2015年4月于本院240例接受股骨颈骨折内固定术老年患者，随机分为地佐辛组(D组)和芬太尼组(F组)，每组120例。观察及评估两组患者术后6、24、48 h视觉模拟评分(VAS)，记录患者年龄、性别、体重，记录术中出血量、手术时间及麻醉时间等手术相关情况。分别于麻醉前1 d和术后1、3、7 d记录简易智力状态检查表(MMSE)评分，静脉采血测定血清S-100B蛋白水平。 结果 术后1 d两组、术后3 d F组MMSE评分较麻醉前1 d明显降低(P<0.05)，两组术后7 d MMSE评分和血清S-100B蛋白含量恢复至正常水平；与F组相比，D组术后1、3 d的MMSE评分均明显升高(P<0.05)，F组患者术后3 d POCD发生率为12.5%，明显高于D组的3.3%(P<0.05)；与D组相比，F组术后3 d血清S-100B蛋白含量显著增高(P<0.05)。 结论 地佐辛和芬太尼静脉镇痛均可引起老年患者短暂的术后认知功能下降，应用地佐辛静脉镇痛认知功能较早恢复至术前水平。
[关键词] 地佐辛；老年患者；术后认知功能；术后镇痛
[中图分类号] R971+.2 [文献标识码] A [文章编号] 1674-4721(2015)07(b)-0102-04
[Abstract] Objective To explore the influence of dezocine and fentanyl for intravenous analgesia on postoperative cognitive function in elderly patients. Methods Two hundred and forty elderly patients undergone internal fixation of femoral neck fracture from May 2014 to April 2015 in our hospital were evenly divided into dezocine group (group D) and fentanyl group (group F) in random.The scores of visual analog scale (VAS) 6， 24，48 h after surgery was observed and evaluated respectively.The age，gender，body weight，intraoperative amount of bleeding，operation time，and anesthesia time were recorded.Scores of mini-mental state examination (MMSE) one day before anesthetization， 1，3，7 d after surgery was recorded respectively.The serum S-100B protein level by venous blood was tested. Results In group F，the score of MMSE 1 and 3 d after surgery were greatly decreased in comparison with that 1 d before anesthetization(P<0.05)，and then returned to be normal 7 d after surgery between two groups respectively.Compared with group F，scores of MMSE 1 d and 3 d after surgery was obviously increased in group D respectively(P<0.05).The incidence of postoperative cognitive dysfunction(POCD) 3 d after surgery in group F was 12.5%，much higher than that in group D accounting for 3.3%(P<0.05).In comparison with group D，the serum S-100B protein level 3 d after surgery in group F was remarkably increased (P<0.05). Conclusion Both dezocine and fentanyl for intravenous analgesia can lead to short-term postoperative cognitive function decline in elderly patients，but the cognitive function in the former one gets recovery to the preoperative level earlier.
[Key words] Dezocine；Elderly patient；Postoperative cognitive function；Postoperative analgesia
地佐辛是一种新型阿片受体激动-拮抗剂，具有镇痛作用强、呼吸抑制轻、依赖性低等特点，目前临床广泛用于术后镇痛治疗。术后认知功能障碍(POCD)是麻醉后常见的中枢神经系统并发症，有研究表明，阿片类药物可损害大脑边缘系统，影响认知功能[1-2]。与芬太尼比较，关于老年患者全身麻醉后使用地佐辛静脉镇痛与术后认知功能障碍的关系相关报道甚少。本研究通过比较地佐辛和芬太尼静脉镇痛对老年患者术后早期认知功能的影响，为临床应用提供参考。 (刘礼胜 钱伟民 董文芳等)
[关键词] 地佐辛；老年患者；术后认知功能；术后镇痛
[中图分类号] R971+.2 [文献标识码] A [文章编号] 1674-4721(2015)07(b)-0102-04
[Abstract] Objective To explore the influence of dezocine and fentanyl for intravenous analgesia on postoperative cognitive function in elderly patients. Methods Two hundred and forty elderly patients undergone internal fixation of femoral neck fracture from May 2014 to April 2015 in our hospital were evenly divided into dezocine group (group D) and fentanyl group (group F) in random.The scores of visual analog scale (VAS) 6， 24，48 h after surgery was observed and evaluated respectively.The age，gender，body weight，intraoperative amount of bleeding，operation time，and anesthesia time were recorded.Scores of mini-mental state examination (MMSE) one day before anesthetization， 1，3，7 d after surgery was recorded respectively.The serum S-100B protein level by venous blood was tested. Results In group F，the score of MMSE 1 and 3 d after surgery were greatly decreased in comparison with that 1 d before anesthetization(P<0.05)，and then returned to be normal 7 d after surgery between two groups respectively.Compared with group F，scores of MMSE 1 d and 3 d after surgery was obviously increased in group D respectively(P<0.05).The incidence of postoperative cognitive dysfunction(POCD) 3 d after surgery in group F was 12.5%，much higher than that in group D accounting for 3.3%(P<0.05).In comparison with group D，the serum S-100B protein level 3 d after surgery in group F was remarkably increased (P<0.05). Conclusion Both dezocine and fentanyl for intravenous analgesia can lead to short-term postoperative cognitive function decline in elderly patients，but the cognitive function in the former one gets recovery to the preoperative level earlier.
[Key words] Dezocine；Elderly patient；Postoperative cognitive function；Postoperative analgesia
地佐辛是一种新型阿片受体激动-拮抗剂，具有镇痛作用强、呼吸抑制轻、依赖性低等特点，目前临床广泛用于术后镇痛治疗。术后认知功能障碍(POCD)是麻醉后常见的中枢神经系统并发症，有研究表明，阿片类药物可损害大脑边缘系统，影响认知功能[1-2]。与芬太尼比较，关于老年患者全身麻醉后使用地佐辛静脉镇痛与术后认知功能障碍的关系相关报道甚少。本研究通过比较地佐辛和芬太尼静脉镇痛对老年患者术后早期认知功能的影响，为临床应用提供参考。 (刘礼胜 钱伟民 董文芳等)