CAJ | 학술논문

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豫，明显高于D组的3.3豫(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。
목적：탐토지좌신여분태니정맥진통대노년환자술후인지공능적영향。방법선택2014년5월~2015년4월우본원240례접수고골경골절내고정술노년환자，수궤분위지좌신조(D조)화분태니조(F조)，매조120례。관찰급평고량조환자술후6、24、48 h시각모의평분(VAS)，기록환자년령、성별、체중，기록술중출혈량、수술시간급마취시간등수술상관정황。분별우마취전1 d화술후1、3、7 d기록간역지력상태검사표(MMSE)평분，정맥채혈측정혈청S-100B단백수평。결과술후1 d량조、술후3 d F조MMSE평분교마취전1 d명현강저(P<0.05)，량조술후7 d MMSE평분화혈청S-100B단백함량회복지정상수평；여F조상비，D조술후1、3 d적MMSE평분균명현승고(P<0.05)，F조환자술후3 d POCD발생솔위12.5예，명현고우D조적3.3예(P<0.05)；여D조상비，F조술후3 d혈청S-100B단백함량현저증고(P<0.05)。결론지좌신화분태니정맥진통균가인기노년환자단잠적술후인지공능하강，응용지좌신정맥진통인지공능교조회복지술전수평。
Objective To explore the influence of dezocine and fentanyl for intravenous analgesia on postoperative cog-nitive 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 postopera-tive 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 remark-ably increased (P<0.05). Conclusion Both dezocine and fentanyl for intravenous analgesia can lead to short-term post-operative cognitive function decline in elderly patients,but the cognitive function in the former one gets recovery to the preoperative level earlier.