帕瑞昔布钠-舒芬太尼患者皮下自控镇痛对脊柱手术患者术后谵妄的影响

陈学强; 黄春贵; 余丽鲜; 杨云丽

帕瑞昔布钠-舒芬太尼患者皮下自控镇痛对脊柱手术患者术后谵妄的影响

1. 迪庆州人民医院麻醉科
2. 昆明总医院麻醉科

基金项目:

基金：云南省教育厅科学研究基金项目资助 (2010ZC179);

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出版历程
- 收稿日期: 2017-09-10

The Effect of PCSA with Parecoxib Sodium and Sufentanil on the Postoperative Delirium in Patients after the Spinal Surgery

Funds:

基金：云南省教育厅科学研究基金项目资助 (2010ZC179);

摘要

摘要: 目的评价帕瑞昔布钠-舒芬太尼患者皮下自控镇痛技术 (patient controlled subcutaneous analgesia PCSA) 对脊柱手术患者术后谵妄的影响.方法择期全身麻醉下脊柱手术患者240例, ASAⅡ-Ⅲ, 年龄1864岁, 术后分为2组, NO-PCSA组 (术后疼痛时哌替啶2550 mg肌肉注射n=120) ;PCSA组 (术后PCSA:舒芬太尼0.9μg/ (kg·d) 帕瑞昔布纳120 mg+托烷司琼10 mg+生理盐水150 m L, 负荷剂量2 m L, 背景输注速率2m L/h, 单次按压剂量 (PCA) 0.5 m L, 锁定时间为15 min, VAS评分>5时哌替啶丁2550 mg肌肉注射n=120) .用视觉模拟评分法 (VAS评分) 分别对2组术后2、24、48、72 h进行疼痛评分;用谵妄评定法评估术后2、24、48、72 h内发生谵妄的情况.结果与NO-PCSA组比较, PCSA组术后3 d VAS评分明显下降, 且术后谵妄发生率降低 (P<0.05) , 差异有统计学意义.结论脊柱手术后帕瑞昔布钠-舒芬太尼患者皮下自控镇痛效果好, 且可降低术后谵妄的发生率.
- 患者皮下自控镇痛 /
- 脊柱手术 /
- 术后谵妄 /
- 手术后并发症
Abstract: Objective To investigate the effect of patient controlled subcutaneous analgesia (PCSA) of Sufentamil and Parecoxib sodium on the postoperative delirium in patients after the spinal surgery. Methods 240 patients with ASA Ⅱ-Ⅲ age 18-64 yrs after the spinal surgery were divided into two groups: group NO-PCSA (analgesic management: patients were accepted pethidine 25-50 mg intramuscular injection n = 120) ; group PCSA (analgesic management: patient controlled subcutaneous analgesia was started since skin suture with the following composition: Sufentanil 0.9 ug/ (kg.d) + Parecoxib sodium 120 mg + Tropisetron 10 mg + normal saline 150 m L. The PCSA setting was as follows: background infusion at 2 m L/h, a bolus dose of 0.5 m L, lockout interval 15 min. If the VAS was greater than 5, patient was accepted pethidine 25-50 mg intramuscular injection n = 120) .The effect of analgesia was assessed by visual analogue scale (VAS) . The delirium was assessed by the confusion assessment, VAS and delirium were recorded with in 2, 24, 48, 72 hours postoperatively. Results During the analgesia period, the VAS and the incidence of postoperative delirium were significantly lower in group PCSA than those in group NO-PCSA (P <0.05) . Conclusion PCSA of Sufentamil and Parecoxib sodium have a good postoperative analgesic effect in patients after the spinal surgery. It is an effective measure and the incidence of postoperative delirium can be decreased by reliefing postoperative pain.
- Patient Controlled Subcutaneous analgesia (PCSA) /
- Spinal surgery /
- Postoperative Delirium /
- Postoperative complication

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参考文献(13)

[1]张承华, 麻伟青, 杨云丽, 等.全凭静脉麻醉下脊柱手术患者术后谵妄的危险因素[J].中华麻醉学杂志, 2010, 30 (9) :1062-1064.
[2]	[2]INOUYE S K, VAN DYCK C H, ALESSI C A, et al.Clarifying confusion:the confusion assessment method.A new method for detection of delirium[J].Ann Intern Med, 1990, 113 (12) :941-948.
[3]	[3]SI HB, YANG T M, ZENG Y, et al.Correlation between inflammatorycytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty[J].BMC Musculoskeletal Disorders, 2017, 18 (1) :265.
[4]	[4]MORI T, MIYAMOTO T, YOSHIDA H, et al.IL-1βand TNFα-initiated IL-6-STAT3 pathway is critical in mediating inflammatory cytokines and RANKL expression in inflammatory arthritis[J].Int Immunol, 20011, 23 (11) :701-712.
[5]	[5]PAPADOPOULOS G, KARANIKOLAS M, LIARMAKOPOU A, et al.Cerebral oximetry and cognitive dysfunction in elderly patients undergoing surgery for hip fractures:a prospective observational study[J].Open Orthop J, 2012, 6 (6) :400-406.
[6]	[6]TERRANDO N, ERIKSSON LI, RYU J K, et al.Resolving postoperative neuroinflammation and cognitive decline[J].Annals Neurology, 2011, 70 (6) :986-995
[7]	[7]MORRISON R S, MAGAZINER J, GILBERT M, et al.Relationship between pain and opioid analgesics on the development of delirium following hip fracture[J].J Gerontol A Biol Sci Med Sci, 2003, 58 (1) :76-81.
[8]	[8]MISTRALETTI G, CARLONI E, CIGADA M, et al.Sleep and delirium in the intensive care unit[J].Minerva Anestesio, 2008, 74 (6) :329-333.
[9]	[9]YILDIZELI B, OZYURTKAN M O, BATIREL H F, et al.Factors associated with postoperative delirium after thoracic surgery[J].Ann Thorac Surg, 2005, 79 (3) :1004-1009.
[10]张承华, 黄青青, 麻伟青.术后谵妄的研究进展[J].昆明医学院学报, 2009, 30 (3) :102-107.
[11]杨云丽, 魏辉明, 张承华, 等.氯诺昔康对老年患者全髋置换术后舒芬太尼皮下自控镇痛效果的影响[J].中国临床药理学与治疗学, 2014, 19 (2) :190-195.
[12]李娟, 唐朝亮, 康芳, 等.帕瑞昔布钠用于颅脑手术患者的镇痛效果及对血浆-内啡肽的影响[J].临床麻醉学杂志, 2012, 28 (6) :537-539.
[13]吴运香, 魏昕, 章敏, 等.帕瑞昔布钠对老年患者胃癌术后早期谁知功能的影响[J].临床麻醉学杂志, 2015, 30 (4) :320-322.

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