中国临床实用医学
中國臨床實用醫學
중국림상실용의학
CHINA CLINICAL PRACTICAL MEDICINE
2010年
2期
1-2
,共2页
王哲银%王定一%任永功%李菡葳%刁文波
王哲銀%王定一%任永功%李菡葳%刁文波
왕철은%왕정일%임영공%리함위%조문파
镇痛%认知功能%老年
鎮痛%認知功能%老年
진통%인지공능%노년
Analgesia%Cognitive function%Elderly
目的 探讨不同的术后镇痛方法对老年患者认知功能的影响的差异性,为提高老年患者术后生活质量,减轻认知功能扰乱提供依据.方法 选择行腹部手术患者64例,年龄60岁以上术前无明显认知障碍,不合并脑血管疾患,无呼吸功能障碍,无肝肾功能障碍.实施连续硬膜外麻醉,随机分为2组,每组32例.经硬膜外自控镇痛组(PCEA组):术后先给0.25%罗哌卡因6 ml+吗啡1～1.5 mg+氟哌利多1.25 mg负荷镇痛剂量,尔后用100 ml0.25%罗哌卡因+吗啡5 mg+氟哌利多2.5 mg作术后2 d PCEA.持续注入速率2.0 ml/h,PCEA量1.0 ml/次,锁定时间为15 min.经外周静脉自控镇痛组(PCIA组):吗啡1.0 mg/ml+氟哌利多0.2 mg/ml,负荷镇痛剂量5.0 ml,PCIA量1.0 ml/次,持续注入速率1.0 ml/h,锁定时间为15 min.分别于术前、术后1 d和3 d进行认知功能测定.结果 两组患者术后自控镇痛,其疼痛视觉评分无差异,均达到满意效果.术后1 d PCIA组有近半数患者认知功能测试异常,与PCEA组比较:P＜0.01,PCIA术后镇痛对认知功能改变更加明显.由此说明,术后镇痛单从认知功能改变考量,PCEA较PCIA优越.结论 PCIA与PCEA应用于老年患者下腹部手术术后镇痛,均能达到满意的术后镇痛,但PCIA影响术后认知功能较PCEA明显.因此,术后镇痛选用PCEA较PCIA优越.
目的 探討不同的術後鎮痛方法對老年患者認知功能的影響的差異性,為提高老年患者術後生活質量,減輕認知功能擾亂提供依據.方法 選擇行腹部手術患者64例,年齡60歲以上術前無明顯認知障礙,不閤併腦血管疾患,無呼吸功能障礙,無肝腎功能障礙.實施連續硬膜外痳醉,隨機分為2組,每組32例.經硬膜外自控鎮痛組(PCEA組):術後先給0.25%囉哌卡因6 ml+嗎啡1～1.5 mg+氟哌利多1.25 mg負荷鎮痛劑量,爾後用100 ml0.25%囉哌卡因+嗎啡5 mg+氟哌利多2.5 mg作術後2 d PCEA.持續註入速率2.0 ml/h,PCEA量1.0 ml/次,鎖定時間為15 min.經外週靜脈自控鎮痛組(PCIA組):嗎啡1.0 mg/ml+氟哌利多0.2 mg/ml,負荷鎮痛劑量5.0 ml,PCIA量1.0 ml/次,持續註入速率1.0 ml/h,鎖定時間為15 min.分彆于術前、術後1 d和3 d進行認知功能測定.結果 兩組患者術後自控鎮痛,其疼痛視覺評分無差異,均達到滿意效果.術後1 d PCIA組有近半數患者認知功能測試異常,與PCEA組比較:P＜0.01,PCIA術後鎮痛對認知功能改變更加明顯.由此說明,術後鎮痛單從認知功能改變攷量,PCEA較PCIA優越.結論 PCIA與PCEA應用于老年患者下腹部手術術後鎮痛,均能達到滿意的術後鎮痛,但PCIA影響術後認知功能較PCEA明顯.因此,術後鎮痛選用PCEA較PCIA優越.
목적 탐토불동적술후진통방법대노년환자인지공능적영향적차이성,위제고노년환자술후생활질량,감경인지공능우란제공의거.방법 선택행복부수술환자64례,년령60세이상술전무명현인지장애,불합병뇌혈관질환,무호흡공능장애,무간신공능장애.실시련속경막외마취,수궤분위2조,매조32례.경경막외자공진통조(PCEA조):술후선급0.25%라고잡인6 ml+마배1～1.5 mg+불고리다1.25 mg부하진통제량,이후용100 ml0.25%라고잡인+마배5 mg+불고리다2.5 mg작술후2 d PCEA.지속주입속솔2.0 ml/h,PCEA량1.0 ml/차,쇄정시간위15 min.경외주정맥자공진통조(PCIA조):마배1.0 mg/ml+불고리다0.2 mg/ml,부하진통제량5.0 ml,PCIA량1.0 ml/차,지속주입속솔1.0 ml/h,쇄정시간위15 min.분별우술전、술후1 d화3 d진행인지공능측정.결과 량조환자술후자공진통,기동통시각평분무차이,균체도만의효과.술후1 d PCIA조유근반수환자인지공능측시이상,여PCEA조비교:P＜0.01,PCIA술후진통대인지공능개변경가명현.유차설명,술후진통단종인지공능개변고량,PCEA교PCIA우월.결론 PCIA여PCEA응용우노년환자하복부수술술후진통,균능체도만의적술후진통,단PCIA영향술후인지공능교PCEA명현.인차,술후진통선용PCEA교PCIA우월.
Objective To observe cognitive effects after epidural vs vein postoperative analgesia in older adults. Methods 64 patients, age ≥ 60 years old, ASA grade Ⅰ～Ⅱ, scheduled for abdominal surgery by epidural anaesthesia were divided randomly into two groups:patient controlled epidural analgesia (PCEA)group ( group PCEA, n = 32 ): commenced with a loading dose of 6 ml ( 0.25% ropivacaine with morphine 1.0 ～ 1.5 mg and droperidol 1.25 mg) ,and continuous epidurally infusion of 0.25% ropivacaine( 100 ml with morphine 5 mg and droperidol 2.5 mg) ,the PCEA pump was set up with 1 ml bolus with a 15 min lockout interval and a background infusion at 2.0 ml/h. patient controlled intravenous analgesia ( PC IA) group ( group PCIA, n = 32 ): receiving continuous intravenous analgesia with 0.1% morphine( with droperidol 0.2 mg/ml), commenced with a loading dose of 5.0 ml,the PCIA pump was set up with 1 ml bolus with a 15 min lockout interval and a background infusion at. 1.0 ml/h for postoperative analgesia. Postoperative analgesic effect was assessed by visual analog scales(VAS,0 ～ 100). Results the outcome of cognitive function at the before operation, 1 d and 3 d after operation. Results Both groups were equally effective in postoperative analgesia. about 50% patients had impact of the cognitive function in the group PCIA at 1 d after operation, Compared with the group PCEA, the impact of the cognitive function of group PCIA were more significantly. Conclusion PCEA is more suitable for the postoperative analgesia in the elderly.
