小剂量吗啡椎管内镇痛在老年患者下肢骨科手术中的应用效果及对认知功能障碍发生的影响

doi:10.20047/j.issn1673-7210.2023.04.26

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Abstract Objective To explore the application effect of low-dose Morphine intraspinal analgesia lower limb orthopedics department surgery in the elderly patients and its influence on the occurrence of postoperative cognitive dysfunction (POCD). Methods A total of 82 elderly patients with lower limb fracture who were admitted to the Second People’s Hospital of Zhangjiagang, Jiangsu Province from July 2020 to July 2021 were selected. They were divided into control group (41 cases) and study group (41 cases) according to the random number table method. Both groups were given combined lumbar and epidural anesthesia. After the operation, 1.5 mg Morphine was injected into the epidural space. Operation time and intraoperative and postoperative usage of Dexmedetomidine were compared between two groups; the incidence of POCD one and two weeks after operation was compared between two groups; the scores of mini-mental state examination scale (MMSE) before operation and one week after operation were compared between two groups; visual analog scale (VAS) scores were compared between two groups before operation, and 6 and 48 h after operation; the occurrence of adverse reactions in two groups was observed. Results There were no significant differences in operation time, and intraoperative and postoperative usage of Dexmedetomidine between two groups (P＞0.05). VAS scores of two groups at different time points were statistically significant (P＜0.05); 6 and 48 h after operation, VAS score of study group was lower than that of control group, and the differences were statistically significant (P＜0.05). The incidence of POCD in study group was lower than that in control group one and two weeks after operation, and the difference was statistically significant (P＜0.05). At one week after operation, MMSE scores in both groups were lower than those before operation, and those in study group were higher than those in control group, and the differences were statistically significant (P＜0.05). There was no significant difference in the total incidence of adverse reactions between two groups (P＞0.05). Conclusion The application of low-dose Morphine intraspinal analgesia in lower limb orthopedics department surgery in elderly patients can reduce the intraoperative and postoperative use of Dexmedetomidine, reduce the incidence of POCD, improve cognitive function and relieve pain.

Key words： The elderly Lower limb fracture surgery Morphine Intraspinal anesthesia Cognitive impairment

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	ZHANG Jingtao1 JIA Xiaoming2 SHI Huayong1

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ZHANG Jingtao1 JIA Xiaoming2 SHI Huayong1. Effect of low-dose Morphine intraspinal analgesia in lower limb orthopedics department surgery in the elderly patients and its influence on the occurrence of cognition impairment[J]. 中国医药导报, 2023, 20(4): 116-119.

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https://www.yiyaodaobao.com.cn/EN/10.20047/j.issn1673-7210.2023.04.26 OR https://www.yiyaodaobao.com.cn/EN/Y2023/V20/I4/116

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