不同术后镇痛方法对老年患者认知功能的影响

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6ml＋吗啡1～1．5mg＋氟哌利多1．25mg负荷镇痛剂量，尔后用100m10．25％罗哌卡因＋吗啡5mg＋氟哌利多2．5mg作术后2dPCEA。持续注入速率2．0ml／h，PCEA量1．0ml／次，锁定时间为15min。经外周静脉自控镇痛组（PCIA组）：吗啡1．0mg／ml＋氟哌利多0．2mg／ml，负荷镇痛剂量5．0ml，PCIA量1．0ml／次，持续注入速率1．0ml／h，锁定时间为15min。分别于术前、术后1d和3d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1dPCIA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。

Cognitive Effects after Epidural vs Vein Postoperative Analgesia in Older Adults

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.