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纳美芬超前镇痛对老年关节置换术后患者早期认知功能的影响

来源:用户上传      作者: 郑侃

  [摘要] 目的 探讨纳美芬超前镇痛对老年关节置换患者早期认知功能的影响。 方法 将80例行关节置换术老年患者随机分成治疗组与对照组,各40例,治疗组采用纳美芬超前镇痛,对照组采用纳洛酮超前镇痛。 结果 治疗组各时点心率(HR)和平均动脉压(MAP)变化差异无统计学意义(P > 0.05)。对照组手术时、拔管时较麻醉前、镇痛时及治疗组,HR明显增快,MAP明显升高(P < 0.05)。治疗组的术后睁眼时间和拔管时间都明显少于对照组(P < 0.05)。治疗组治疗后的HAMD总分、焦虑/躯体化、认识障碍得分比治疗前低(P < 0.05),对照组无明显变化(P > 0.05)。 结论 纳美芬超前镇痛应用于老年关节置换患者中,易于维持血流动力学稳定,同时利于早期认知功能的恢复,值得推广应用。
  [关键词] 纳美芬;纳洛酮;超前镇痛;老年人;关节置换患者;早期认知功能
  [中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210(2012)07(b)-0058-02
  The early cognitive function effects of Nalmefene preemptive analgesia for joint replacement elderly patients
  ZHENG Kan
  Department of Anesthesiology, Beijing Shijingshan Hospital, Beijing 100043, China
  [Abstract] Objective To investigate the early cognitive function effects of Nalmefene preemptive analgesia for joint replacement elderly patients. Methods 80 elderly patients with joint replacement were randomly divided into treatment group and control group, each for 40 cases, the treatment group were given the Nalmefene preemptive analgesia, and the control group were given Naloxone preemptive analgesia. Results The heart rate (HR) and mean arterial pressure (MAP) changes at each time point in treatment group had no significant differences (P > 0.05), but had significant differences (P < 0.05) in the control group of surgery, before extubation compared to anesthesia, analgesia time (P < 0.05). The opening eyes and extubation time of the treatment group were significantly less than the control group (P < 0.05). The HAMD total score, anxiety/somatization, recognizing obstacles score of the treatment group were lower than the control group after treatment (P < 0.05). Conclusion Nalmefene preemptive analgesia in elderly patients with joint replacement can maintain hemodynamic stability, it is conducive to the early recovery of cognitive function that should be widely applied.
  [Key words] Nalmefene; Naloxone; Preemptive analgesia; Elderly; Joint replacement patients; Early cognitive function
  理想的老年关节置换术麻醉要求麻醉镇痛迅速,术中血液动力学稳定,停药后患者苏醒快而完全,对于认知功能无影响[1]。纳美芬是一种可静脉注射用的长效阿片类拮抗剂,与纳络酮同属于羟吗啡酮类衍生物,药理作用基本相同而半衰期显著增长[2]。有研究研究证实了静脉注射纳美芬和纳洛酮对吗啡产生的呼吸抑制具有同等的拮抗作用[3]。还有研究显示,纳美芬超前镇痛可影响老年人的身心健康,从而导老年人的认知和人际交往发生问题,能对自身与家庭造成严重的后果[4]。本文为此具体探讨了纳美芬超前镇痛对老年关节置换患者后早期认知功能的影响。
  1 资料与方法
  1.1 一般资料
  随机选择我院自2009年2月~2011年6月择期行关节置换患者80例,ASA I~Ⅱ级,年龄最小60岁,最大85岁,平均(66.5±6.5)岁,入选患者均无严重心肺疾患,无本文所用手术与药物应用过敏状况。男45例,女35例,体重最轻49 kg,最重80 kg,平均65.5 kg。将其随机分为两组:治疗组与对照组,各40例,两组一般资料比较,差异无统计学意义(P > 0.05),具有可比性。
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