盐酸戊乙奎醚对接受口腔颌面部手术的老年患者认知功能的影响

目的: 探讨麻醉前应用阿托品以及不同剂量盐酸戊乙奎醚对接受口腔颌面部手术的老年患者术后认知功能的影响。方法: 选择2017年12月—2018年7月于上海交通大学医学院附属第九人民医院择期行口腔颌面部手术的老年患者134例,麻醉诱导前随机接受阿托品0.5 mg（A组,n=32）、盐酸戊乙奎醚0.01 mg/kg（C1组,n=34）、盐酸戊乙奎醚0.015 mg/kg（C2组,n=33）、生理盐水（NS组,n=35）作为术前用药。比较4组患者术前焦虑评分、术前认知功能评分、用药后生命体征变化、口腔腺体分泌程度、手术时间、失血量、苏醒时间、术后疼痛评估、术后认知功能评分。采用SPSS 18.0软件包对数据进行统计分析。结果: A组患者用药后心率变化较其余3组显著升高（P<0.05）,A组、C1组、C2组患者用药后在准备室需要吸引口腔内分泌物次数较对照组显著减少（P<0.05）,C2组苏醒时间较其余3组显著延长（P<0.05）,MMSE评分显著下降（P<0.05）。结论: 麻醉诱导前应用小剂量（0.01 mg/kg）盐酸戊乙奎醚,不延长苏醒时间、不增加术后认知功能下降风险,同时其抑制口腔腺体分泌效果好,对老年患者心肺系统影响较小,是老年口腔颌面部手术患者理想的术前用药。

Effect of penehyclidine hydrochloride on cognitive function in elderly patients undergoing oral and maxillofacial surgery

PURPOSE: To investigate the effect of atropine and different doses of penehyclidine hydrochloride on postoperative cognitive function in elderly patients undergoing oral and maxillofacial surgery. METHODS: One hundred and thirty-four elderly patients undergoing oral and maxillofacial surgery at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from December 2017 to July 2018 were included in the study. The patients randomly received atropine 0.5 mg (group A, n=32), penehyclidine hydrochloride 0.01 mg/kg (C1 group, n=34), penehyclidine hydrochloride 0.015 mg/kg (C2 group, n=33), normal saline (NS group, n=35) as preoperative medication. Preoperative anxiety scores, preoperative cognitive function scores, changes in vital signs after drug administration, degree of oral gland secretion, operation time, blood loss, recovery time, postoperative pain assessment, and postoperative cognitive function scores were compared between the four groups using SPSS18.0 software package. RESULTS: The changes of heart rate in group A was significantly higher than that in the other three groups (P<0.05). The number of oral secretions of patients in group A, C1 and C2 was significantly lower than that in the control group (P<0.05). The recovery time of C2 group was significantly longer than that of the other three groups (P<0.05), and the MMSE score was significantly decreased (P<0.05). CONCLUSIONS: Low dose (0.01 mg/kg) of penehyclidine hydrochloride before anesthesia induction does not prolong the recovery time, increase the risk of postoperative cognitive decline. At the same time, 0.01 mg/kg penehyclidine hydrochloride inhibits the secretion of salivary gland, and has little effect on cardiopulmonary system in elderly patients undergoing oral and maxillofacial surgery.