摘要
目的:探讨罗哌卡因联合帕瑞昔布钠对老年妇科腹腔镜术后疼痛及认知功能的影响。方法:选择2017年10月-2019年11月本院拟择期行妇科腹腔镜手术的≥检查60岁老年患者102例,随机分为对照组和观察组各51例。麻醉诱导后,观察组术前给予帕瑞昔布钠静脉注射40mg,对照组给予生理盐水静脉推注。比较两组手术情况、术后不同时间点疼痛程度、拔管即刻与拔管后5min麻醉恢复质量和术前与术后24h、72h认知功能,不良反应。结果:拔管时间、睁眼时间、麻醉时间、手术时间两组均无差异(P>0.05),观察组静脉自控镇痛泵(PCA)按压次数少于对照组,术后1h、2h、4h、8h及12h主诉症状视觉模拟评分均低于对照组(P<0.05);两组拔管即刻躁动评分低于拔管后5min,Ramsay镇静评分高于拔管后5min,且观察组上述评分变化幅度大于对照组(均P<0.05);术后24h、72h两组精神状态检查表评分均低于术前,术后72h评分高于术后24h,且观察组术后24h、72h高于对照组(均P<0.05);观察组术后72h内认知功能障碍发生率(9.8%)低于对照组(25.5%)(P<0.05),不良反应总发生率(9.8%)与对照组(7.8%)无差异(P>0.05)。结论:罗哌卡因局部阻滞联合帕瑞昔布钠超前镇痛的术后镇痛效果良好,可提高麻醉恢复质量,降低老年患者术后认知障碍,安全性良好。
Objective:To investigate the effects of ropivacaine combined with parecoxib sodium used in laparoscopic gynecological surgery of elderly patients on their postoperation pain and cognitive function.Methods:102 elderly patients who were scheduled to undergo laparoscopic gynecological surgery between October 2017 and November 2019 were selected and randomly divided into control group and observation group(51 cases in each group).After induction of anesthesia,the patients in the observation group were given 40 mg of parecoxib sodium intravenously before surgery,and the patients in the control group were given normal saline intravenously before surgery.The patients in both groups were given 10ml of 0.5%ropivacaine for local infiltration incision around each laparoscopic operation hole before establishing pneumoperitoneum,and were given 10ml of 0.5%ropivacaine to spray the pelvic cavity before removing the perforator at the end of surgery.The general conditions of surgery,degree of pain at different time points after surgery,quality of anesthesia recovery immediately and at 5 min after extubation,cognitive function before surgery and at 24h and 72h after surgery,and adverse reactions rate of the patients were compared between the two groups.Results:There were no significant differences in extubation time,eye-opening time,anesthesia time,and operation time of the patients between the two groups(P>0.05).The number of pressing of controlled intravenous analgesia pump(PCA)of the patients in the observation group was significant less than that of the patients in the control group.Visual analogue score(VAS)as the chief complaints of the patients in the observation group at 1h,2h,4h,8h,or 12h after surgery was significant lower than that of the patients in the control group(P<0.05).The score of agitation immediately after extubation of the patients in both groups was significant lower than that 5min after extubation.Ramsay sedation score of the patients in both groups was significant higher than that 5min after extubation,and which variation range of the patients in the observation group was significant more than that of the patients in the control group(all P<0.05).The mini mental status examination(MMSE)score of the patients in the two groups at 24h and 72h after surgery had decreased significantly(P<0.05),which of the patients in the two groups at 72h after surgery was significant higher than that at 24h after surgery(P<0.05),and which of the patients in the observation group at 24h and 72h after surgery were significant higher than those of the patients in the control group(all P<0.05).The incidence(9.8%)of postoperative cognitive function disorder(POCD)within 72h after surgery of the patients in the observation group was significant lower than that(25.5%)of the patients in the control group(P<0.05).The total incidence rate of adverse reactions(9.8%vs.7.8%)of the patients had no significant different between the two groups(P>0.05).Conclusion:Ropivacaine local block combined with parecoxib sodium preemptive analgesia used in laparoscopic gynecological surgery of elderly patients has good postoperative analgesic effect,which can improve the quality of anesthesia recovery and reduce POCD with good safety.
作者
罗力
王殿超
LUO Li;WANG Dianchao(The Third People's Hospital of Xindu District, Chengdu, Sichuan Province, 610504)
出处
《中国计划生育学杂志》
2021年第8期1618-1622,共5页
Chinese Journal of Family Planning
关键词
老年妇女
腹腔镜手术
罗哌卡因
帕瑞昔布钠
术后疼痛
认知功能
Elderly women
Laparoscopic gynecological surgery
Ropivacaine
Parecoxib sodium
Postoperative pain
Cognitive function
