摘要
目的 探讨脑电双频谱指数(BIS)监测靶控输注右美托咪定联合全身麻醉对老年骨折手术患者的应用效果及对麻醉深度影响.方法 回顾性选取2018年8月至2023年8月连云港市第二人民医院收治的老年骨折患者70例作为研究对象,按照麻醉方法不同分为对照组(n=20)、观察A组(n=25)和观察B组(n=25).对照组采取咪达唑仑0.05 mg/kg+舒芬太尼0.5 μg/kg+依托咪酯0.3 mg/kg+罗库溴铵0.6 mg/kg进行全身麻醉,观察A组在全身麻醉前增加0.5 μg/kg右美托咪定静脉泵注,观察B组在麻醉诱导前采取BIS把控输注右美托咪定,浓度为0.6 mg/mL.比较3组患者麻醉效果,分别在3组患者入室时(T1)、切皮时(T2)、手术开始后20 min(T3)、手术结束即刻(T4)的血氧饱和度(SpO2)、收缩压、舒张压、心率水平评价麻醉深度情况,比较3组患者丙泊酚用量、术中舒芬太尼用量、苏醒时间、手术时间、术中出血量,最后比较不良反应发生情况.结果 观察B组的麻醉效果Ⅰ级患者比例为88.00％,高于观察A组(60.00％)和对照组(40.00％),麻醉效果Ⅲ级患者比例为0,低于观察A组(4.00％)和对照组(25.00％),差异均有统计学意义(P＜0.05).T1和T4时,3组患者SpO2、心率、收缩压、舒张压比较,差异均无统计学意义(P＞0.05);T2和T3时,观察B组和观察A组SpO2均高于对照组,心率、收缩压、舒张压均低于对照组,差异均有统计学意义(P＜0.05);观察B组与观察A组各时间点的舒张压、收缩压、心率及T1和T4的SpO2比较,差异均无统计学意义(P＞0.05).两组患者手术时间、术中出血量比较,差异均无统计学意义(P＞0.05),观察B组患者术中丙泊酚、舒芬太尼用量、苏醒时间分别为(467.25±73.27)mg、(957.25±163.73)μg、(5.82±1.21)min,均明显低(短)于观察 A 组[(565.25± 43.25)mg、(996.35±127.84)μg、(7.85±1.32)min]和对照组[(687.25±68.36)mg、(1 126.35±179.26)μg、(10.87 ±1.36)min],差异均有统计学意义(P＜0.05).观察B组不良反应发生率为4.00％,低于观察A组(24.00％)与对照组(45.00％),差异有统计学意义(P＜0.05).结论 BIS监测靶控输注右美托咪定联合全身麻醉针对老年骨折手术患者应用效果更优,同时该方法麻醉深度较好,可稳定患者术中生命体征,减少麻醉药物用量,且可降低患者麻醉不良反应发生率,值得临床应用推广.
Abstract
Objective To explore the application effect of target controlled infusion of dexmedetomidine combined with general anesthesia in elderly fracture surgery patients monitored by bispectral index(BIS)and its impact on anesthesia depth.Methods Seventy elderly patients with fractures admitted to the Second People's Hospital of Lianyungang City from August 2018 to August 2023 were retrospectively selected as the study subjects.They were divided into the control group(n=20),the observation group A(n=25),and the observation group B(n=25)according to different anesthesia methods.The control group received midazolam 0.05 mg/kg+sufentanil 0.5 μg/kg+etomidate 0.3 mg/kg+rocuronium 0.6 mg/kg for general anesthesia,the observation A group received intravenous infusion of 0.5 μg/kg dexmedetomidine before general anesthesia,and the observation group B received BIS controlled infusion of dexmedetomidine at a concentration of 0.6 mg/mL before anesthesia in-duction.The anesthesia effects of three groups of patients were compared.The depth of anesthesia by measuring the levels of blood oxygen satura-tion(SpO2),systolic blood pressure,diastolic blood pressure,and heart rate at the time of entry(T1),skin incision(T2),20 minutes after sur-gery(T3),and immediately after surgery(T4)were evaluated.The dosage of propofol,intraoperative sufentanil,awakening time,surgical time,and intraoperative bleeding volume among the three groups of patients were compared.Finally,the occurrence of adverse reactions was compared.Results The proportion of grade I patients in the observation group B was 88.00％,which was higher than that in the observation group A(60.00％)and the control group(40.00％),the proportion of grade Ⅲ patients in the observation group B was 0,which was lower than that in the observation group A(4.00％)and the control group(25.00％),and the differences were statistically significant(P＜0.05).There were no statistically significant differences in SpO2,systolic blood pressure,diastolic blood pressure,and heart rate among the three groups of patients at T,and T4(P＞0.05).At T2 and T3 time,SpO2 in the observation group B and the observation A were higher than those in the control group,while heart rate,systolic blood pressure,and diastolic blood pressure in the observation group B and the observation A were lower than those in the control group,and the differences were statistically significant(P＜0.05).There were no statistically significant differences between diastolic,systolic blood pressure,heart rate,and SpO2 contrast at T1 and T4 in the observation group B and the observation A(P＞0.05).There were no statistically significant differences in surgical time and intraoperative bleeding between the two groups of patients(P＞0.05).The intraoperative dosage of propofol and sufentanil,as well as the recovery time in the observation group B were(467.25±73.27)mg,(957.25±163.73)μg,(5.82±1.21)min,respectively,which were lower(shorter)than those in the observation group A[(565.25±43.25)mg,(996.35±127.84)μg,(7.85±1.32)min]and the control group[(687.25±68.36)mg,(1 126.35±179.26)μg,(10.87±1.36)min],and the differences were statistically significant(P＜0.05).The incidence of adverse reactions in the observation group B was 4.00％,which was lower than those in the observation group A(24.00％)and the control group(45.00％),and the difference was statistically significant(P＜0.05).Conclu-sion Target-controlled infusion of dexmedetomidine combined with general anesthesia using BIS monitoring is more effective for elderly patients undergoing fracture surgery.At the same time,this method has a better anesthesia depth,can stabilize the patient's intraoperative vital signs,re-duce the dosage of anesthetic drugs,and reduce the occurrence of adverse reactions in patients.It is worthy of clinical application and promotion.
基金项目
江苏省"333高层次人才培养工程"项目(BRA2019248)
维普
万方数据