吸烟及非吸烟老年患者开胸术后镇痛镇静及认知功能比较

目的 比较吸烟及非吸烟老年患者开胸术后的镇痛镇静效果、术后谵妄及认知功能障碍的发生率.方法 选择ASA分级Ⅰ～Ⅱ级择期行开胸手术患者59例,根据术前有无吸烟史,分为吸烟组（n=32）和非吸烟组（n=27）.术毕行椎旁阻滞镇痛,辅助给予舒芬太尼、曲马多、氟哌利多静脉自控镇痛.记录术后2h、24 h静息及咳嗽状态下疼痛视觉模拟评分（VAS评分）,RASS镇静深度评分及CAM-ICU量表谵妄状态评估,及术前、术后24 h认知功能（MMSE）评分.结果 （1）吸烟组患者在术后2h、24 h静息及咳嗽状态下VAS评分均大于非吸烟组（P＜0.05）;吸烟组在术后2h、24 h静息状态和咳嗽状态的VAS评分≥4分的构成比均高于非吸烟组（P＜0.01）.（2）术后2h躁动发生率吸烟组为18.8％,非吸烟组为7.4％（两者相差11.4％,P=0.263）,差异无统计学意义.（3）吸烟组术后谵妄发生率为18.8％,非吸烟组术后谵妄发生率为3.7％,（两者相差15.1％,P=0.108）,差异无统计学意义.（4）吸烟组术后24h术后认知功能障碍（POCD）发生率与非吸烟组相比,差异无统计学意义（P=0.474）.结论 老年吸烟者对切口痛的敏感度较非吸烟者高.

A comparison of postoperative analgesia,sedation and cognitive function in elderly smoker and nonsmoker after thoracotomy

Objective To compare the differences in postoperative analgesia,sedation and cognitive function between smoker and nonsmoker after thoracotomy.Method Fifty-nine cases of the elderly patients （ASAⅠ ～Ⅱ） undergoing elective thoracic operation were divided into smoking group （n =32） and non-smoking group （n =27） according to their preoperative smoking history.Paravertebral block was performed in all patients before extubation.At the same time,they were auxiliary given sufentanil,tramado land droperidol for patient-controlled intravenous analgesia.The pain visual analogue score （VAS score） in resting and coughing condition at 2 h,24 h after surgrry、RASS score、CAM-ICU table delirium condition assessment and cognitive score （MMSE） before and after surgery were recorded.Results （1） The VAS scores inresting and cough condition at 2 h and 24 h after surgery were higher in the smoking group than those in the non-smoking group （P＜ 0.05）; The constituent ratio of VAS score ≥ 4 in resting and cough condition at 2 h and 24 h after surgerywere significantly higher in smoking group than in those of non-smoking group （P＜0.05）; （2） The incidence of postoperative agitation was 18.8％in the smoking group,and 7.4％in the non-smoking group,respectively （P=0.263）; （3） The incidence of postoperative delirium was 10.3％ in the smoking group and 1.7％ in thenon-smoking group was,respectively （P=0.066）; （4） There was no significant difference in the incidence of postoperative cognitive dysfunction between thetwo groups （P =0.474）.Conclusion Elderly smokers are more sensitive to pain than non-smoker after thoracotomy.