右美托咪定复合芬太尼静脉自控镇痛对老年患者术后睡眠及认知功能的影响
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摘要
目的探讨右美托咪定复合芬太尼静脉自控镇痛(PCIA)对老年患者术后睡眠和认知功能的影响。方法选择拟行胸科手术需使用静脉镇痛泵的老年患者40例,随机分为对照组(芬太尼组)和实验组(右美托咪定+芬太尼组)各20例。术后对照组镇痛泵配方为芬太尼15μg/kg+托烷司琼5 mg混合生理盐水到100 mL,实验组镇痛泵配方为芬太尼15μg/kg+右美托咪定1. 0μg/kg+托烷司琼5 mg混合生理盐水到100 mL,2组均48 h后撤泵。观察2组患者术前1 d、手术当天及术后3 d的睡眠时间并评价睡眠质量,记录术前1 d及术后1、3、7 d的简易精神状态量表(MMSE)评分以及术后认知功能障碍(POCD)发生率。结果与对照组相比,实验组手术当天和术后2 d的睡眠时间显著更长,睡眠质量评分显著升高(P <0. 05);实验组术后1、3 d的MMSE评分显著高于对照组(P <0. 05);实验组术后1、3 d的POCD发生率显著低于对照组(P <0. 05)。结论老年手术患者术后应用右美托咪定复合芬太尼静脉自控镇痛,有助于改善患者术后睡眠剥夺状态,且认知功能降低少。
Objective To investigate the effect of dexmedetomidine combined with fentanil on postoperative sleep quality and cognitive function in elderly patients with patient-controlled intravenous analgesia( PCIA). Methods Forty elderly patients underwent thoracic surgery were randomly divided into control group( fentanil group,n = 20) and experimental group C( fentanil plus dexmedetomidine group,n = 20),The control group was mixed 15 μg/kg fentanil and 5 mg tropisetron into100 mL of normal saline in patient-controlled intravenous analgesia pump,and experimental group contained 15 μg/kg fentanil,1. 0 μg/kg dexmedetomidine and 5 mg tropisetron in 100 mL of normal saline. The pump was withdrawn after 48 h. The total steep time,sleep quality were recorded at 1 d before surgery and on the day of surgery,and at 3 d after surgery. The Mini-Mental Status Examination( MMSE) were recorded at 1 d before surgery and 1,3,7 d after surgery,and the incidence of postoperative cognitive dysfunction was observed. Results Compared with control group,the sleep time of experimental group on the surgery day and at 2 d after surgery was longer( P < 0. 05); the sleep quality were significantly higher( P < 0. 05); the MMSE scores of experimental group on the first and third postoperative day were higher( P < 0. 05),and the incidence of POPD was lower than that in the control group( P < 0. 05). Conclusion Dexmedetomidine combined with fentanil administered for postoperative analgesia in elderly patients shows better efficacy in improvement of sleep status,and improve the postoperative cognitive function.
Objective To investigate the effect of dexmedetomidine combined with fentanil on postoperative sleep quality and cognitive function in elderly patients with patient-controlled intravenous analgesia( PCIA). Methods Forty elderly patients underwent thoracic surgery were randomly divided into control group( fentanil group,n = 20) and experimental group C( fentanil plus dexmedetomidine group,n = 20),The control group was mixed 15 μg/kg fentanil and 5 mg tropisetron into100 mL of normal saline in patient-controlled intravenous analgesia pump,and experimental group contained 15 μg/kg fentanil,1. 0 μg/kg dexmedetomidine and 5 mg tropisetron in 100 mL of normal saline. The pump was withdrawn after 48 h. The total steep time,sleep quality were recorded at 1 d before surgery and on the day of surgery,and at 3 d after surgery. The Mini-Mental Status Examination( MMSE) were recorded at 1 d before surgery and 1,3,7 d after surgery,and the incidence of postoperative cognitive dysfunction was observed. Results Compared with control group,the sleep time of experimental group on the surgery day and at 2 d after surgery was longer( P < 0. 05); the sleep quality were significantly higher( P < 0. 05); the MMSE scores of experimental group on the first and third postoperative day were higher( P < 0. 05),and the incidence of POPD was lower than that in the control group( P < 0. 05). Conclusion Dexmedetomidine combined with fentanil administered for postoperative analgesia in elderly patients shows better efficacy in improvement of sleep status,and improve the postoperative cognitive function.
引文
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[9] Nelson L E,Lu J,Guo T Z,et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleeppromoting pathway to exert its sedative effects[J]. Anesthesiology,2003,98(2):428-436.
[10] Li Y H,He R,Chen S F,et al. Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy[J]. Exp Ther Med,2015,10(5):1635-1642.
[2] Krenk L,Jennum P,Kehlet H. Sleep disturbances after fasttrack hip and knee arthroplasty[J]. Br J Anaesth,2012,109(5):769-775.
[3] Wang D,Teichtahl H. Opioids,sleep architecture and sleep-disordered breathing[J]. Sleep Med Rev,2007,11(1):35-46.
[4] Huupponen E,Maksimow A,Lapinlampi P,et al. Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep[J]. Acta Anaesthesiol Scand,2008,52(2):289-294.
[5] Rasmussen L S. Defining postoperative cognitive dysfunction[J]. Eur J Anaesthesiol,1998,15(6):761-764.
[6] Wu X H,Cui F,Zhang C,et al. Low-dose dexmedetomidine improves sleep quality pattern in elderly patients after noncardiac surgery in the intensive care unit:a pilot randomized controlled trial[J]. Anesthesiology,2016,125(5):979-991.
[7]杜海亮,陈欢,裴凌,等.睡眠剥夺对异丙酚麻醉大鼠认知功能的影响[J].中华麻醉学杂志,2016,36(2):161-164.
[8]彭志友,封小美,薛庆生,等.胸科手术术后认知功能障碍的危险因素分析[J].临床麻醉学杂志,2011,27(5):433-435.
[9] Nelson L E,Lu J,Guo T Z,et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleeppromoting pathway to exert its sedative effects[J]. Anesthesiology,2003,98(2):428-436.
[10] Li Y H,He R,Chen S F,et al. Effect of dexmedetomidine on early postoperative cognitive dysfunction and peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy[J]. Exp Ther Med,2015,10(5):1635-1642.