Effect of dexmedetomidine combined with fentanil on postoperative sleep quality and cognitive function in elderly patients with patient-controlled intravenous analgesia
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摘要:目的 探讨右美托咪定复合芬太尼静脉自控镇痛(PCIA)对老年患者术后睡眠和认知功能的影响。方法 选择拟行胸科手术需使用静脉镇痛泵的老年患者40例，随机分为对照组(芬太尼组)和实验组(右美托咪定+芬太尼组)各20例。术后对照组镇痛泵配方为芬太尼15 μg/kg+托烷司琼5 mg混合生理盐水到100 mL, 实验组镇痛泵配方为芬太尼15 μg/kg+右美托咪定1.0 μg/kg+托烷司琼5 mg混合生理盐水到100 mL, 2组均48 h后撤泵。观察2组患者术前1 d、手术当天及术后3 d的睡眠时间并评价睡眠质量，记录术前1 d及术后1、3、7 d的简易精神状态量表(MMSE)评分以及术后认知功能障碍(POCD)发生率。结果 与对照组相比，实验组手术当天和术后2 d的睡眠时间显著更长，睡眠质量评分显著升高(P < 0.05); 实验组术后1、3 d的MMSE评分显著高于对照组(P < 0.05); 实验组术后1、3 d的POCD发生率显著低于对照组(P < 0.05)。结论 老年手术患者术后应用右美托咪定复合芬太尼静脉自控镇痛，有助于改善患者术后睡眠剥夺状态，且认知功能降低少。Abstract:Objective To investigate the effect of dexmedetomidine combined with fentanil on postoperative sleep quality and cognitive function in elderly patients with patient-controlled intravenous analgesia(PCIA).Methods Forty elderly patients underwent thoracic surgery were randomly divided into control group(fentanil group, n=20) and experimental group C (fentanil plus dexmedetomidine group, n=20), The control group was mixed 15 μg/kg fentanil and 5 mg tropisetron into 100 mL of normal saline in patient-controlled intravenous analgesia pump, and experimental group contained 15 μg/kg fentanil, 1.0 μg/kg dexmedetomidine and 5 mg tropisetron in 100 mL of normal saline. The pump was withdrawn after 48 h. The total steep time, sleep quality were recorded at 1 d before surgery and on the day of surgery, and at 3 d after surgery. The Mini-Mental Status Examination (MMSE) were recorded at 1 d before surgery and 1, 3, 7 d after surgery, and the incidence of postoperative cognitive dysfunction was observed.Results Compared with control group, the sleep time of experimental group on the surgery day and at 2 d after surgery was longer (P < 0.05); the sleep quality were significantly higher(P < 0.05); the MMSE scores of experimental group on the first and third postoperative day were higher(P < 0.05), and the incidence of POPD was lower than that in the control group(P < 0.05).Conclusion Dexmedetomidine combined with fentanil administered for postoperative analgesia in elderly patients shows better efficacy in improvement of sleep status, and improve the postoperative cognitive function.
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Keywords:
- dexmedetomidine /
- fentanil /
- elderly patients /
- sleep /
- cognitive function
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表 1 2组患者一般情况、麻醉时间、手术时间比较(x±s)
组别 n 男 女 年龄/岁 身高/cm 体质量/kg ASAⅠ级/例 ASAⅡ级/例 麻醉时间/min 手术时间/min 对照组 20 14 6 67.0±3.0 165.0±16.0 66.0±8.0 7 13 260.0±19.0 236.0±14.0 实验组 20 13 7 68.0±4.0 166.0±18.0 67.0±8.0 8 12 263.0±17.0 232.0±13.0 
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表 2 2组患者患者不同时点睡眠时间比较(x±s)
h 组别 n 术前1 d 手术当天 术后1 d 术后2 d 术后3 d 对照组 20 8.2±0.8 5.6±0.7 6.3±0.6 6.5±0.5 7.2±0.7 实验组 20 8.1±0.7 6.9±0.6* 7.2±0.4* 7.3±5.6* 7.5±0.6 与对照组比较, *P < 0.05。
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表 3 2组患者不同时点睡眠质量比较(x±s)
cm 组别 n 术前1 d 手术当天 术后1 d 术后2 d 术后3 d 对照组 20 8.9±0.8 5.5±0.7 6.3±0.8 7.1±0.5 7.7±0.6 实验组 20 9.0±0.7 7.7±0.6* 8.3±0.4* 7.9±0.7* 8.3±0.5 与对照组比较, *P < 0.05。
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表 4 2组患者不同时点MMSE评分比较(x±s)
分 组别 n 术前1 d 术后1 d 术后3 d 术后7 d 对照组 20 28.4±0.9 23.6±0.8 25.3±0.8 27.2±0.6 实验组 20 28.5±0.9 26.5±0.9* 27.6±0.7* 28.3±0.7 与对照组比较, *P < 0.05。
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表 5 2组患者术后POCD发生情况比较[n(%)]
组别 n 术后1 d 术后3 d 术后7 d 对照组 20 6(30.0) 4(20.0) 1(5.0) 实验组 20 2(10.0)* 1(5.0)* 0 与对照组比较, *P < 0.05。
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