硬膜外隙预注小剂量吗啡超前镇痛对高龄患者术后认知功能的影响

目的观察术前硬膜外隙预注小剂量吗啡超前镇痛对高龄患者术后认知功能的影响。方法选择在硬膜外麻醉下行单侧人工全髋关节置换术且麻醉效果确切的的高龄患者84例,随机均分为A、B两组。A组在麻醉平面出现后,0.75%布比卡因5～10mL注入硬膜外隙前,吗啡1.5mg注入硬膜外隙。B组在术毕将吗啡1.5mg注入硬膜外隙。观察并记录两组患者术后镇痛持续时间、术后镇痛中恶心、呕吐等不良反应。分别于术后4、8、12、20、24、30、36和48h进行镇痛及舒适度评分。并分别于术前1d、术后1d、术后3d和术后7d由本院同一心理医师采用神经心理学测试技术简易智力状态检查(MMSE)评定患者认知功能。结果 A组综合镇痛质量明显优于B组,镇痛时间长于B组(P<0.05);与术前1d比较,B组于术后1d及术后3d时MMSE评分明显降低(P<0.05);与B组比较,A组于术后1d及3d时MMSE评分明显升高(P<0.05),A、B两组POCD的发生率分别为6.1%和14.2%,A组明显低于B组(P<0.05)结论硬膜外隙预注小剂量吗啡超前镇痛可降低高龄患者术后认知功能障碍的发生率

Effect of Preoperative Epidural Preinjection of Minidose Morphine for Preemptive Analgesia for Elderly Patients on Postoperative Cognitive Function

Objective To study the effect of preoperative epidural preinjection of minidose morphine for preemptive analgesia for elderly patients on postoperative cognitive function.Methods Eighty-four elderly patients choosed for unilateral total hip arthroplasty with the exact effective epidural anesthesia were divided randomly and averagely into Group A and Group B： in group A,1.5mg morphine were injected into epidural space for preemptive analgesia after blocking level appearance and before 5～10mL 0.75% bupivacaine were injected into epidural space;and in group B 1.5mg morphine were injected into epidural space at the end of the operation.Postoperative analgesia duration、adverse reactions such as nausea and vomiting during postoperative analgesia were observed and recorded in two groups,and analgesia and comfort scores were respectively calculated at 4,8,12,20,24,30,36 and 48h after operation.The scores of Mini-Mental State Examination（MMSE） were assessed in the preoperative 1 day、postoperative 1 day,3 day and 7 day by the same psychiatrist for the cognitive function in patients.Results The comprehensive quality of postoperative analgesia in group A was superer than in group B,and the analgesia duration was longer than in group B（P0.05）.In group B,MMSE score in postoperative 1 day and 3 day was significantly lower than in preoperative 1 day（P0.05）;compared with Group B,MMSE score increased significantly in group A from postoperative1 d and 3d（P0.05）,The incidences of POCD in group A and group B were respectively 6.1% and 14.2%,it was significantly lower in group A than in group B（P0.05）.Conclusion Preoperative epidural preinjection of minidose morphine for preemptive analgesia for elderly patients can signicantly reduce the incidence of postoperative cognitive dysfunction.