国际麻醉学与复苏杂志   2021, Issue (11): 9-9
    
羟考酮术后镇痛对老年患者术后早期认知功能及神经损伤标记物水平的影响
支连军, 沈莹, 王宗, 朱晓昌, 顾琴1()
1.苏州相城区人民医院
Effects of postoperative analgesia with oxycodone on early postoperative cognitive dysfunction and central nerve injury in aged patients
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摘要：

目的 观察羟考酮术后镇痛对老年患者术后早期认知功能和神经损伤标记物水平的影响。 方法 全身麻醉下行择期腹腔镜胆囊切除术的老年患者112例，按随机数字表法分为对照组（53例）和羟考酮组（59例），两组患者术后分别使用舒芬太尼和羟考酮进行患者自控静脉镇痛（patient controlled intravenous analgesia, PCIA）。于术前1 d及术后1、2、3 d检测患者血浆S‑100β蛋白和神经元特异性烯醇化酶（neuron‑specific enolase, NSE）水平；术前1 d及术后7、30 d应用蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）评估患者认知功能；记录患者术后2、6、12、24、48 h的VAS疼痛评分，术后48 h内术后恶心呕吐（postoperative nausea and vomiting, PONV）、皮肤瘙痒的发生率及术后7、30 d术后认知功能障碍（postoperative cognitive dysfunction， POCD）发生率。 结果 与术前1 d比较，两组患者术后7 d MoCA评分降低（P<0.05）。术后7 d羟考酮组MoCA评分高于对照组（P<0.05）。与对照组比较，羟考酮组术后48 h内PONV、皮肤瘙痒发生率及术后7 d POCD发生率降低（P<0.05）。与术前1 d比较，两组患者术后1、2、3 d血浆S‑100β蛋白、NSE水平升高（P<0.05）。术后2、3 d羟考酮组血浆S‑100β蛋白水平低于对照组（P<0.05），术后1、2、3 d，羟考酮组患者血浆NSE水平低于对照组（P<0.05）。其余指标差异无统计学意义（P>0.05）。 结论 羟考酮用于老年患者术后镇痛可能具有一定脑保护作用，提高患者术后舒适性，改善术后早期认知功能。
关键词： 术后镇痛； 羟考酮； 脑保护； 术后认知功能障碍
Abstract:

Objective To investigate the effect of postoperative analgesia with oxycodone on early cognitive functions in aged patients and the change of nerve injury markers in plasma. Methods A total of 112 patients were enrolled in the present study who were scheduled for laparoscopic cholecystectomy with general anesthesia. The patients were divided randomly into two groups, control group (n=53) and oxycodone group (n=59) according to the random number table method. Patient controlled intravenous analgesia (PCIA) with sufentanil and oxycodone were used for pain control, respectively. Blood samples were taken on 1 d before operation, 1, 2 d and 3 d after operation for determination of plasma S‑100β protein and neuron specific enolase (NSE) concentrations. Neuropsychological testing was performed with Montreal Cognitive Assessment (MoCA) on 1 d before operation, 7 d and 30 d after operation to evaluate patients' cognitive functions. Visual Analog Scale (VAS) scores of all patients were recorded for at 2, 6, 12, 24 h and 48 h postoperatively. The incidence rates of postoperative nausea and vomiting (PONV) and itching were recorded at 48 h postoperatively. The incidence rate of postoperative cognitive dysfunction (POCD) was recorded on 7 d and 30 d after operation. Results Compared with the baseline, MoCA scores were significantly decreased in two groups on postoperative day 7 (P<0.05). MoCA scores in oxycodone group were higher than control (P<0.05) and POCD incidence in oxycodone group was decreased on postoperative day 7 (P<0.05). PONV in oxycodone group were less than control group on within 48 h after surgery (P<0.05). Compared with the baseline, the plasma S‑100β protein and NSE concentrations were both significantly increased in two groups within three days after surgery (P<0.05). The plasma S‑100β protein concentrations in oxycodone group were lower than control group at 2 d and 3 d after surgery (P<0.05). The plasma NSE concentrations in oxycodone group were lower than control group at 1, 2 d and 3 d after surgery (P<0.05). There was no statistical significance between two groups in other indicators (P>0.05). Conclusions Oxycodone, which can be used for postoperative analgesia, may have a certain protective effect of brain and improve early postoperative cognitive function in aged patients.
Key words: Postoperative analgesia; Oxycodone; Brain protection; Postoperative cognitive dysfunction