CAJ | 학술논문

目的评价右美托咪定复合舒芬太尼患者静脉自控镇痛(PCIA)对老年脊柱手术患者术后早期认知功能的影响.方法全麻下择期脊柱手术老年患者152例,年龄＞60岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,随机分为2组:S组仅采用舒芬太尼实施PCIA(n=77);D组采用右美托咪定复合舒芬太尼实施PCIA(n =75).于术后1、2、6、12、24和48 h采用11点数字评分(NRS)评估患者静息和翻身活动时的疼痛程度;于术后1～3d采用意识错乱评估法(CAM)评估术后谵妄(POD)的发生情况;于术前1d和术后1周进行韦氏记忆量表数字广度及视觉再认和联想学习分测验(包括顺背数字、倒背数字、视觉再认、联想学习)、Stroop色码干扰测验、韦氏成人智力量表数字符号替代分测验(DSST)、数字连线测验(Part A)等神经认知测验,评估术后认知功能障碍(POCD)的发生情况.结果 D组静息NRS评分和活动NRS评分自术后6h均低于S组(均P＜0.05).S组和D组分别有8例(10.4％)和3例(4.0％)患者发生POD,差异无统计学意义(x2=1.457,P＞0.05),且S组有2例POD患者需采用利培酮治疗.S组和D组分别有15例(19.5％)和6例(8.0％)患者出现POCD,差异有统计学意义(x2=4.206,P＜0.05).S组术后1周的倒背数字评分、视觉再认评分、DSST评分和Stroop测验完成时间分别为(3.7±1.3)分、(7.7±2.0)分、(25.2±7.8)分和(56.9±14.8)s,与术前的(4.1±1.1)分、(8.8±1.8)分、(28.2±7.6)分和(50.2±14.7)s比较,差异有统计学意义(t=2.132、3.585、2.427、-2.822,均P＜0.05),而D组仅倒背数字评分与术前比较显著下降[(3.6±1.2)分比(4.0±1.2)分,t=2.144,P＜0.05].结论右美托咪定复合舒芬太尼PCIA可改善老年脊柱手术患者的术后镇痛效果和术后早期认知功能.
목적 평개우미탁미정복합서분태니환자정맥자공진통(PCIA)대노년척주수술환자술후조기인지공능적영향.방법 전마하택기척주수술노년환자152례,년령＞60세,미국마취의사협회(ASA)분급Ⅰ～Ⅲ급,수궤분위2조:S조부채용서분태니실시PCIA(n=77);D조채용우미탁미정복합서분태니실시PCIA(n =75).우술후1、2、6、12、24화48 h채용11점수자평분(NRS)평고환자정식화번신활동시적동통정도;우술후1～3d채용의식착란평고법(CAM)평고술후섬망(POD)적발생정황;우술전1d화술후1주진행위씨기억량표수자엄도급시각재인화련상학습분측험(포괄순배수자、도배수자、시각재인、련상학습)、Stroop색마간우측험、위씨성인지역량표수자부호체대분측험(DSST)、수자련선측험(Part A)등신경인지측험,평고술후인지공능장애(POCD)적발생정황.결과 D조정식NRS평분화활동NRS평분자술후6h균저우S조(균P＜0.05).S조화D조분별유8례(10.4％)화3례(4.0％)환자발생POD,차이무통계학의의(x2=1.457,P＞0.05),차S조유2례POD환자수채용리배동치료.S조화D조분별유15례(19.5％)화6례(8.0％)환자출현POCD,차이유통계학의의(x2=4.206,P＜0.05).S조술후1주적도배수자평분、시각재인평분、DSST평분화Stroop측험완성시간분별위(3.7±1.3)분、(7.7±2.0)분、(25.2±7.8)분화(56.9±14.8)s,여술전적(4.1±1.1)분、(8.8±1.8)분、(28.2±7.6)분화(50.2±14.7)s비교,차이유통계학의의(t=2.132、3.585、2.427、-2.822,균P＜0.05),이D조부도배수자평분여술전비교현저하강[(3.6±1.2)분비(4.0±1.2)분,t=2.144,P＜0.05].결론 우미탁미정복합서분태니PCIA가개선노년척주수술환자적술후진통효과화술후조기인지공능.
Objective To explore the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine and sufentanil on early postoperative cognition in elderly patients after spine surgery.Methods One hundred fifty-two patients aged more than 60 yr with ASA Ⅰ-Ⅲ undergoing eiective spine surgery were randomly assigned into two groups:Group S received PCIA with only sufentanil (n =77);Group D received PCIA with dexmedetomidine and sufentanil (n =75).The severity of pain at rest and upon movement was measured at 1,2,6,12,24 and 48 h after surgery using the 11-point numerical rating scale (NRS).Delirium was assessed daily within three days after surgery via the confusion assessment method.Cognitive function was measured at the day before surgery and at one week after surgery using a battery of neuropsychologic tests including Digit Span (forward and backward) subtests and Visual Retention and Paired Associate Verbal Learning subtests of Wechsler Memory Scale,Stroop Color Word Interference Test,Digit Symbol Substitution subtest of Wechsler Adult Intelligence Scale (DSST) and Trail Making Test (Part A).Results The NRS scores at rest and upon movement at 6 to 48 h after surgery were lower in Group D than those in Group S (P ＜ 0.05).Postoperative delirium (POD) was present in 8 (10.4％) patients in Group S and 3 (4.0％) patients in Group D (x2 =4.206,P ＞ 0.05).Two patients with POD in Group S were treated with risperidone.Postoperative cognitive dysfunction (POCD) was present in 15 (19.5％) patients in Group S and 6 (8.0％) patients in Group D (x2 =4.206,P ＜ 0.05).Compared with the preoperative baselines,the scores of Digit Span backward,Visual Retention and DSST were significantly lower(3.7 ±1.3 vs4.1 ±1.1,7.7±2.0 vs8.8 ±1.8,25.2±7.8 vs28.2±7.6;t=2.132,3.585,2.427,respectively,P ＜ 0.05) and the time to complete Stroop test was significantly longer in Group S (56.9 ± 14.8 vs 50.2 ± 14.7,t =-2.822,P ＜ 0.05),while only the score of Digit Span backward was significantly lower in Group D (3.6 ± 1.2 vs 4.0 ± 1.2,t =2.144,P ＜ 0.05).Conclusion Dexmedetomidine combined with sufentanil in postoperative PCIA can result in superior analgesia and improve early postoperative cognitive function.