两种麻醉方式对老年髋关节置换术后认知功能及镇痛效果的影响
The effect of two kinds of anesthesia on the cognitive function and analgesia in elderly patients after hip arthroplasty
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摘要: 目的:探讨氟比洛芬酯联合舒芬太尼与单用舒芬太尼对老年髋关节置换术患者术后认知功能及镇痛效果的影响.方法:选取120例行髋关节置换术的患者为研究对象,按照随机数字表法将患者分为氟比洛芬酯联合舒芬太尼镇痛组(A组)和舒芬太尼镇痛组(B组)各60例.A组患者麻醉诱导后给予氟比洛芬酯100 mg+舒芬太尼2.0 mg,稀释至200 ml,自控镇痛(PCIA)为2 ml/30 min,B组麻醉诱导后给予舒芬太尼2.0 mg,稀释至200 ml,PCIA为2 ml/30 min.分别于术后3 h、6 h、12 h、24 h和48 h采用视觉模拟评分法对2组患者镇痛效果进行评分.分别于术前、术后1 d、3 d和5 d采用简易智力状态检查法对2组认知功能进行评定.记录2组患者术后1 h、24 h、48 h舒芬太尼用量、PCIA次数及患者并发症情况.结果:A组术后3 h、6 h、12 h和24 h视觉模拟评分均明显低于B组(P<0.01).A组术后1 d、3 d和5 d简易智力状态检查法评分均高于B组(P<0.05~P<0.01).A组术后1 h与24 h舒芬太尼用量和PCIA次数均少于B组(P<0.01).A组患者恶心呕吐、躁动、呼吸抑制和认知功能障碍发生率均低于B组(P<0.05).结论:氟比洛芬酯镇痛能有效降低患者认知功能障碍的发生,提高患者镇静镇痛效果,减少术后舒芬太尼PCIA使用量.Abstract: Objective:To investigate the effects of the sufentanil and flurbiprofen anesthesia on the cognitive function and analgesia in elderly patients after hip arthroplasty.Methods:One hundred and twenty patients treated with hip arthroplasty were divided into the flurbiprofen combined with sufentanil analgesia group(group A) and sufentanil analgesia group(group B) according to random number table(60 cases each group).Group A were treated with 100 mg of flurbiprofen combined with 2.0 mg of sufentanil, diluting to 200 ml, patient-controlled analgesia(PCIA) for 2 ml/30 min.Group B were treated with 2.0 mg of sufentanil, diluting to 200 ml, PCIA for 2 ml/30 min.The analgesic effects in two groups were scored using visual analog scale(VAS) after 3 h, 6 h, 12 h and 24 h of operation.The cognitive function in two groups were assessed using mini-mental state examination(MMSE) before operation and after 1 d, 3 d and 5 d of operation.The sufentanil dosage, PCIA times and complications of two groups were recorded after 1 h, 24 h and 48 h of operation.Results:The VAS scores in group A after 3 h, 6 h, 12 h and 24 h of operation were significantly lower than those in group B(P<0.01).The MMSE scores in group A after 1 d, 3 d and 5 d of operation were higher than those in group B(P<0.05 to P<0.01).The sufentanil dosage and PCIA times in group A after 1 h and 24 h of operation were less than those in group B(P<0.01).The incidence rates of nausea and vomiting, restlessness, respiratory depression and cognitive dysfunction in group A were significantly lower than those in group B(P<0.05).Conclusions:The flurbiprofen analgesia can effectively reduce the incidence of cognitive dysfunction and postoperative PCIA sufentanil usage, and improve sedation analgesia.
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Key words:
- analgesia /
- flurbiprofen /
- sufentanil /
- hip arthroplasty /
- cognitive function
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