瑞芬太尼镇痛对老年人腹腔镜手术患者术后早期认知功能的影响

摘要

Objective To evaluate the effect of remifentanil analgesia on early postoperative cognitive function in elderly patients treated with laparoscopic surgery, and to provide a theoretical reference for reducing postopera-tive cognitive dysfunction (POCD). Methods Sixty-seven cases of patients undergoing laparoscopic surgery were divided into the study group (n=34) and the control group (n=33). The study group was given intraoperative and postoperative target-controlled infusion analgesia (TCIA) of remifentanil, while the control group was given intraoperative and postoperative TCIA of fentanyl. Twenty-four hours before surgery and 12 h, 24 h and 48 h after surgery, the cognitive function of patients in both groups were tested based on Mini Mental State Examination (MMSE), with the incidence of POCD calculated. Results The MMSE scores of postoperative 12 h, 24 h and 48 h in the study group showed no statistically significant difference with that of preoperative 24 h (P>0.05), while that of postoperative 12 h, 24 h and 48 h in the control group decreased significantly (P＜0.05). The MMSE scores of postoperative 12 h, 24 h and 48 h showed significant difference between the two groups (P＜0.05). The incidence of POCD postoperative 12 h and 48 h in the study group were 20.6% and 11.8%, respectively, which was significantly lower than 45.5% and 24.2% in the control group (P<0.05). Conclusion The intraoperative and postoperative TCIA of remifentanil can significantly reduce the incidence of POCD after laparoscopic surgery.%目的 探讨瑞芬太尼对老年人行腹腔镜手术患者术后早期认知功能的影响。方法 67例拟择期行腹腔镜手术的患者分为两组，观察组采用术中和术后瑞芬太尼靶控输注镇痛，对照组采用术中和术后芬太尼靶控输注镇痛。分别于手术前24 h、术后12h、24h、48 h采用简易精神状态检查表(MMSE)对患者进行认知功能测试并计算术后认知功能障碍(POCD)的发生率。结果 观察组术后12h、24 h、48 h的MMSE评分与术前24h比较差异无统计学意义(P＞0.05)，且观察组术后12h、24 h、48 h的MMSE评分与对照组比较差异有统计学意义(p＜0.05)；而对照组术后12h、24h、48 h的MMSE评分与术前24 h比较显著下降，差异有统计学意义(P＜0.05)；观察组术后12h、48 h POCD发生率分别为20.6％和11.8％，对照组分别为45.5％和24.2％，差异有统计学意义(P＜0.05)。结论 瑞芬太尼能明显降低老年人腹腔镜手术患者术后早期POCD的发生。