吗啡静脉自控镇痛对老年患者静脉麻醉腹部手术后早期认知功能的影响

目的:探讨吗啡静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)对老年患者在靶控输注(target control infusion,TCI)全凭静脉麻醉(total intravenous anesthesia,TIVA)下行腹部手术后早期认知功能的影响。方法:120例符合入选标准的老年患者随机分为吗啡PCIA组和对照组,每组60例。两组患者均在TCI/TIVA下行腹部手术,均于术后24 h、48 h进行疼痛视觉模拟评分(visual analogue scale,VAS);术前24 h及术后24 h、48 h、72 h用简易精神状态量表(mini-mental state examination,MMSE)行神经心理学检查,评价认知功能;记录术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率。结果:术后24 h和48 h PCIA组VAS评分显著低于对照组(P0.01);术后72 h PCIA组POCD发生率低于对照组(P0.05),且术后认知功能恢复情况优于对照组(P0.05)。结论:吗啡PCIA可减少老年患者在TCI/TNA下行腹部手术后POCD的发生,并促进术后认知功能的恢复。

Influence of Patient-Controlled Intravenous Analgesia with Morphine on Early Postoperative Cognitive Func-tion in the Elderly Patients Undergoing Abdominal Surgery with Total Intravenous Anesthesia

Objective：To explore the influence of patient-controlled intravenous analgesia（PCIA）with morphine on early post-operative cognitive function in the elderly patients undergoing abdominal surgery with target control infusion（TCI）/total intra-venous anesthesia（TIVA）.Methods：A total of 120 patients matched with the inclusion criteria were randomly divided into PCIA group with morphine（n=60）and control group（n=60）.All the patients underwent abdominal operation with TCI/TI-VA.Pain intensity at 24 h and 48 h after the operation were evaluated by visual analogue scale（VAS）.Mini-mental state examination（MMSE）scores were recorded at 24 h before the operation and 24 h,48 h,72 h after the operation,in order to as-sess cognitive function and incidence of POCD.Results：Scores of VAS in PCIA group were significantly lower than those in control group at 24 h and 48 h after the operation（P 〈0.01）.The incidence of postoperative cognitive dysfunction（POCD）at 72 h after the operation in PCIA group was lower than that in the control group （P 〈0.05）,and recovery of postoperative cog-nitive function in PCIA group was better than that in the control group（P 〈0.05）.Conclusions：PCIA with morphine could re-duce the incidence of POCD in the elderly patients undergoing abdominal surgery and improve postoperative cognitive function.