不同剂量盐酸戊乙奎醚对老年患者术后早期认知功能的影响

摘要

Objective To observe the effects of different doses of penehyclidine hydrochloride on early postoperative cognitive dysfunction (POCD) in elderly. Methods One hundred and twenty patients (65-78 years old, ASA II or Ⅲ) scheduled for elective noncardiac surgery were randomly divided into three groups, group A (low dose group, intravenous 0.005 mg/kg penehyclidine hydrochloride), group B(middle dose group, intravenous 0.01 mg/kg penehyclidine hydrochloride) and group C(high dose group, intravenous 0. 015 mg/kg penehyclidine hydrochloride). SBP.DBP, HR and SpO2 were recorded before injection at 10,20,30 min after injection, respectively. The degree of thirst was evaluated using visual analog scale (VAS) and the volume of intraoperative respiratory secretions were recorded at each sampling time after injection. The cognitive function was evaluated by the mini-mental state examination (MMSE) at pre-operation and at 24, 48 and 72 h of post-operation. Results The amount of secretions from the mouth and the endotracheal in groups A and B were more than that of group C (P<0. 05). The thirst score increased significantly after injection in all groups, especially at 20-30 min after injection (P<0. 05). Compared with groups A and B, thirst degree of the group C was more obvious at 30 mins after injection (P<0. 05). The score of MMSE in group B and C at 24,48 h after injection was slightly lower than that of pre-injection(P<0. 05). The score of MMSE in group A was higher than those in groups B and C(P<0. 05) at 72 h of post-operation. The incidence rate of POCD during the 72 h postoperatively in group A, group B and group C was 10%, 25% and 30%, respectively, and the incidence in groups B and C was obviously higher(P<0. 05). Conclusion Using penehyclidine hydrochlorideat(0. 005-0. 015 mg/kg) in elderly significantly inhibits the secretion of airway glandand without influencing heart rate. However, penehyclidine hydrochloride could lead to dose-related POCD, which showed that low dose might be safer.%目的 观察老年患者术前应用不同剂量盐酸戊乙奎醚对术后认知功能的影响.方法 择期全麻下行非心脏手术老年患者120例,年龄65～78岁,ASAⅡ或Ⅲ级,按照不同剂量盐酸戊乙奎醚均分为:低剂量组(A组)静注盐酸戊乙奎醚0.005 mg/kg、中剂量组(B组)静注盐酸戊乙奎醚0.01 mg/kg和高剂量组(C组)静注盐酸戊乙奎醚0.015 mg/kg.均采用全麻,麻醉诱导和维持用药相同.记录注药前、注药后10、20、30 min的SBP、DBP、HR和SpO2,用VAS评分评定上述各时点患者口干程度,记录术中气道分泌物,术前及术后24、48、72 h采用简易智力状态检查法(MMSE)评估患者认知功能.结果 C组术中气道分泌物明显少于A、B组(P＜0.05)；B、C组认知功能障碍(POCD)发生率明显高于A组(P＜0.05).与注药前比较,注药后20、30 min三组患者口干评分明显升高(P＜0.05)；且C组明显高于A组(P＜0.05).术后24、48hB、C组MMSE评分明显低于术前和A组(P＜0.05).术后72 h内POCD发生率A组(10％)明显低于B组(25％)和C组(30％)(P＜0.05).结论 老年患者术前静注不同剂量盐酸戊乙奎醚明显抑制气道腺体分泌作用,且对心率无影响,但可导致剂量相关的POCD,采用低剂量相对安全.