Comparative Analysis of the Effects of Hydromorphone and Sufentanil on Early Postoperative Cognitive Function in Patients with Intravenous Controlled Analgesia after Radical Resection of Colorectal Cancer
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摘要:
目的 对比氢吗啡酮（HM）与舒芬太尼（SF）用于静脉自控镇痛（PCIA）对结肠癌（CRC）患者术后初期认知功能的影响。 方法 研究对象为85名择期行CRC根治术（含开腹手术或腹腔镜手术）患者，借助随机数字表法，把44例归入HM组（H组），把41例归入SF组（S组）。术后H组实施氢吗啡酮PCIA；S组实施舒芬太尼PCIA。观察记录术后2 d内出现的头晕、恶心呕吐、低血压（LBP）、呼吸抑制、皮肤瘙痒等不良反应（AR）；术后6 h、0.5 d、1 d、2 d VAS（视觉模拟评分）；术后1、2、3 d MMSE（简易智力状态检查量表）评分；术后1 d Ramsay镇静评分。 结果 在术后VAS评分上，2组未见明显不同（P > 0.05）；在术后2 d内AR发生率上，2组比较差异无统计学意义（P > 0.05）；在术后1 d Ramsay镇静评分上，2组比较差异无统计学意义（P > 0.05）；在术后MMSE评分上，2组比较差异有统计学意义（P < 0.05）；在POCD （术后认知功能障碍）发生率上，H组、S组各是15.9%（7/44）、39%（16/41），就此项指标对比2组发现存在明显区别（P < 0.05）；分组因素是POCD出现的独立风险因素（OR = 3.307，P < 0.05）。 结论 HM和SF皆可安全有效用于CRC根治术后患者PCIA，在镇痛效果上无区别；相比于SF，HM可使CRC根治患者的POCD得到显著改善。 Abstract:Objective To compare the effects of hydromorphone and sufentanil on early postoperative cognitive function in patients with colorectal cancer. Methods Eighty-five patients with selective radical resection of colorectal cancerr （including laparoscopic surgery or open surgery） were randomly divided into hydromorphone group of 44 （H group） and sufentanil group of 41 （S group） by random number table method. Postoperative H group was treated with hydromorphone for intravenous analgesia. Group S was treated with sufentanil for intravenous analgesia. Visual analogue score （VAS） was recorded at 6, 12, 24, 48 h after surgery. The adverse reactions such as nausea, vomiting, skin itching, respiratory inhibition, hypotension and dizziness occurred within 48 hours after the operation were observed. Ramsay sedation score was recorded 24 hours after surgery. Mini-Mental State Examination （MMSE） scores were recorded at 1, 2, 3 d after the operation were recorded. Results There was no significant difference in postoperative VAS scores between the two groups （P > 0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups within 48 hours after surgery （P > 0.05）. There was no statistically significant difference in Ramsay sedation score at 24h after surgery between the two groups （P > 0.05）. There was a statistical difference in the postoperative MMSE score between the two groups （P < 0.05）. The incidence of postoperative cognitive dysfunction （POCD） in group H was 15.9% （7/44）, and group S 39% （16/41）. There was a statistical difference in the incidence of POCD between the two groups （P < 0.05）. The grouping factor was an independent one affecting the occurrence of POCD （OR = 3.307, P < 0.05）. Conclusions Hydromorphone and sufentanil are both safe and effective for intravenous controlled analgesia in patients after radical resection of colorectal cancer with no difference in analgesia. Compared with sufentanil, hydromorphone can significantly improve the cognitive impairment of patients after radical colon cancer. -
表 1 2组基线资料比较（
$\bar x \pm s $ ）Table 1. Comparison of baseline data between two groups （
$\bar x \pm s $ ）组别 n 性别（n） 年龄（岁） 文化程度（n） 术前MMSE评分（分） 男 女 小学 中学 大学 H组 44 24 20 55.7 ± 10.0 9 19 16 28.9 ± 0.9 S组 41 23 18 55.2 ± 9.9 10 22 9 29.0 ± 0.9 t/χ2 0.021 0.218 2.129 −0.922 P 0.886 0.828 0.345 0.359 
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组别 术前血肌酐水平
（μmol/L）术前血总胆红素水平
（μmol/L）手术方式（n） 手术时间
（min）术中出血量
（mL）腹腔镜手术 开腹手术 H组 87.5 ± 25.6 12.6 ± 4.3 23 21 177.5 ± 51.4 127.2 ± 59.8 S组 92.0 ± 14.9 13.5 ± 4.7 17 24 175.2 ± 46.2 121.2 ± 34.4 t/χ2 −0.994 −0.885 0.995 0.216 0.571 P 0.324 0.379 0.318 0.830 0.570
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表 2 2组术后VAS评分比较[（
$ \bar x \pm s $ ），分]Table 2. Comparison of postoperative VAS scores between the two groups [（
$ \bar x \pm s $ ），scores]组别 n 术后6 h 术后12 h 术后24 h 术后48 h H组 44 2.17 ± 0.57 2.70 ± 0.49 2.46 ± 0.52 2.17 ± 0.47 S组 41 2.30 ± 0.63 2.57 ± 0.48 2.29 ± 0.39 2.21 ± 0.43 t −0.949 1.197 1.647 −0.342 P 0.345 0.235 0.103 0.734
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表 3 2组术后48 h不良反应发生率比较 [n（%）]
Table 3. Comparison of adverse effects at 48 h between two groups [n（%）]
组别 n 恶心呕吐 皮肤瘙痒 呼吸抑制 低血压 头晕 H组 44 3（6.8） 2（4.5） 0（0.0） 0（0.0） 1（2.3） S组 41 2（4.9） 1（2.4） 0（0.0） 0（0.0） 1（2.4） χ2 0.145 0.283 - - 0.003 P 0.703 0.595 - - 0.960
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表 4 2组术后24 h Ramsay镇静评分比较（n）
Table 4. Comparison of 24 h Ramsay Sedation scores between two groups （n）
组别 n 1分 2分 ≥3分 H组 44 0 41 3 S组 41 0 40 1 χ2 0.194 P 0.660
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表 5 2组术后MMSE评分比较 [（
$ \bar x \pm s $ ），分]Table 5. Comparison of postoperative MMSE scores between two groups [（
$ \bar x \pm s $ ），scores]组别 n 术前 术后1 d 术后2 d 术后3 d H组 44 28.9 ± 0.9 28.3 ± 1.0 28.4 ± 1.1 28.7 ± 0.9 S组 41 29.0 ± 0.9 27.8 ± 1.3 28.1 ± 1.0 28.2 ± 1.0 t −0.922 2.110 1.426 2.914 P 0.359 0.038* 0.158 0.005* *P < 0.05。
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表 6 POCD危险因素分析
Table 6. POCD risk ractor analysis
Logistic回归
（多因素分析）年龄 手术时间 分组因素 术后24 h VAS OR 0.964 1.005 3.307 0.622 P 0.185 0.372 0.026* 0.429 *P < 0.05。
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