摘要
目的拟探讨右美托咪定复合羟考酮用于经皮椎间孔镜手术对老年患者术后认知功能、镇痛效果的影响。方法前瞻性对照研究。选取2022年1月至2023年12月至我院行经皮椎间孔镜腰椎间盘切除术(PELD)的95例老年腰椎间盘突出症患者作为研究对象,按照随机数字表法将其分为试验组(48例)和对照组(47例)。对照组麻醉诱导前使用羟考酮+0.9%氯化钠注射液,试验组麻醉诱导前使用右美托咪定+羟考酮。比较两组患者围术期指标(舒芬太尼用量、手术时间、苏醒时间及拔管时间)、术后简易智能状态检查量表(MMSE)评分、疼痛视觉模拟量表(VAS)评分、疼痛介质[P物质(SP)及前列腺素E2(PGE2)]水平及不良反应。结果试验组和对照组手术前后在MMSE评分、VAS评分、SP及PGE2水平重复测量设计的方差分析显示,试验组和对照组组间在术后各时间点差异存在统计学意义(均P<0.05),组别与时间点间存在交互作用,两组术后MMSE评分呈先降低再升高趋势(P<0.05),术后VAS评分、SP及PGE2水平呈先升高再降低趋势(均P<0.05)。结论将右美托咪定复合羟考酮应用于老年患者PELD,可有效改善患者术后认知功能,降低术后疼痛感、疼痛介质水平,安全可靠。
Objective To investigate the effect of dexmedetomidine combined with oxycodone on postoperative cognitive function and analgesic effect in elderly patients undergoing percutaneous endoscopic lumbar discectomy(PELD).Methods A prospective controlled study was conducted.95 elderly patients with lumbar disc herniation(LDH)who underwent PELD at the hospital from January 2022 to December 2023 were selected as the study subjects.They were divided into the treatment group(48 cases)and the control group(47 cases)using a random number table.The control group was treated with oxycodone plus 0.9%sodi-um chloride injection before anesthesia induction,while the treatment group was treated with dexmedetomi-dine combined with oxycodone before anesthesia induction.The two groups were compared on perioperative indicators(dosage of sufentanil,surgery time,awakening time and extubation time),postoperative Mini Mental State Examination(MMSE)score,Pain Visual Analogue Scale(VAS)score,the levels of pain mediators[sub-stance P(SP)and prostaglandin E2(PGE2)],and adverse reactions.Results Repeated measures analysis of variance found that there were statistically significant differences between the treatment group and the control group in terms of MMSE score,VAS score,SP,and PGE2 level at each time point after surgery(P<0.05).There was interaction between the groups and time points.Postoperative MMSE scores of the two groups showed a de-creasing trend at first and then an increasing trend(P<0.05).Postoperative VAS scores,SP,and PGE2 levels showed an increasing trend at first and then a decreasing trend(P<0.05).Conclusion Applying dexmedetomi-dine combined with oxycodone in PELD for elderly patients can effectively improve their postoperative cogni-tive function,reduce postoperative pain,and lower the levels of pain mediators.Besides,it is safe and reliable.
作者
张骞
唐伟
刘丽丽
Zhang Qian;Tang Wei;Liu Lili(Anesthesiology Department of Rongchang District People's Hospital in Chongqing,Chongqing 402460,China)
出处
《中华老年骨科与康复电子杂志》
2024年第4期209-214,共6页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
基金
重庆市荣昌区科卫联合医学科研项目(2023RCMSXM005)。
关键词
右美托咪定
羟考酮
经皮椎间孔镜手术
老年人
认知功能
Dexmedetomidine
Oxycodone
Percutaneous transforaminal endoscopic surgery
Aged
Cognitive function
