盐酸戊乙奎醚作为麻醉前用药对老年硬膜外麻醉患者术后认知功能的影响

目的:观察盐酸戊乙奎醚作为麻醉前用药对老年硬膜外麻醉患者术后认知功能的影响。方法:选取90例应用连续硬膜外麻醉的择期骨科和泌尿外科手术患者。男性,ASAII~Ⅲ级,年龄(75~89)老年患者,随机将患者分为:低剂量盐酸戊乙奎醚组(LP组)、高剂量组(HP组)和东莨菪碱组(S组)。静脉开放后莫非氏管滴注盐酸戊乙奎醚:HP组0.01mg/kg,LP组0.002mg/kg;S组:东莨菪碱0.002mg/kg;盐酸戊乙奎醚静脉使用后记录HR、BP及唾液分泌情况;术前一天、术后6h、24h、48h、72h用简易精神状态法(Mini-Mental State,MMS)对患者进行评分;记录各组患者术后6h、24h、48h出现定向力、记忆力和认知功能障碍的情况。结果:各组盐酸戊乙奎醚或东莨菪碱静脉使用后HR、BP及唾液分泌无明显差异。MMS:三组患者术前MMS无差异,但与术前相比,术后各时点MMS评分均显著下降(P<0.05);三组之间比较:HP组6h、24h、48h、72h均显著低于LP组和S组(P<0.05),LP组和S组无差异。HP组POCD发生率显著高于LP组和S组(P<0.05)。结论:0.01mg/kg的盐酸戊乙奎醚作为麻醉前用药可增加老年硬膜外麻醉患者POCD的发生,0.002mg/kg的盐酸戊乙奎醚安全、有效。

Effect of Penehyclidine Hydrochloride as Premedication of Epidural Anesthesia on Post-cognitive Function of Elderly Patients

Objective:To observe the effect of penehyclidine hydrochloride as pemedication of epidural anesthesia on postcognitive function of elderly Patients.Methods:90 patients in department of orthopedics and urinary scheduled epidural anesthesia.The patients were male,ASA class II~III,between 75 to 89 years old.The patients were randomly divided into 3 groups:Low dose group of penehyclidine hydrochloride(LP group),High dose of penehyclidine hydrochloride(HP group),Scopolamine group(S group).Penehyclidine hydrochloride was injected by intravenous infuse.HR,BP and salivary secretion were recorded.Mini-mental state(MMS) detection method was used.MMS scores were record at one day before surgery,6h,24h,48h,72h after operation.POCD cases such as the patients’ orientation force,remembrance and cognitive dyfunction were recorded at 6h,24h,48h after operation.Results:There were no significant difference in HR,BP and salivary secretion among three groups.The MMS scores significantly decreased after surgery compared with the preoperation(P<0.05);The MMS scores of HP group was remarkably lower than that of the other two groups(P<0.05),while there was no difference between LP group and S group.The POCD incidence in HP group was significantly higher than that in LP group and S group(P<0.05).Conclusion:Penehyclidine hydrochloride 0.01mg/kg can increase the POCD incidence in aged patients with epidural anesthesia,while penehyclidine hydrochloride 0.002mg/kg is effective and safe