摘要
目的 研究老年髋关节置换术中实施丙泊酚闭环靶控输注麻醉的效果及对术后谵妄风险的影响.方法 回顾性选取2020年1月至2023年1月入安庆市第一人民医院接受治疗的90例髋关节骨折老年患者,择期行髋关节置换术.参考麻醉方式不同分为A组、B组和C组,每组各30例.A组给予丙泊酚闭环靶控持续输注麻醉,B组给予丙泊酚开环靶控持续输注麻醉,C组给予丙泊酚人工持续输注麻醉.比较3组患者的术中相关指标(麻醉时间、手术时间以及拔管时间)、麻醉相关指标(术中丙泊酚总计用量、术中维持泵调节次数)、血流动力学变化[麻醉诱导开始(T0)、插管(T1)、手术开始(T2)、手术结束(T3)、拔管(T4)的平均动脉压、心率以及脑电双频指数(BIS)值]情况、术后恢复情况及术后谵妄发生情况.结果 (1)术中指标:3组患者麻醉时间、手术时间以及拔管时间比较,差异均无统计学意义(P＞0.05).(2)麻醉相关指标:A组患者术中丙泊酚总计用量、术中维持泵调节次数均明显低于B、C组,差异均有统计学意义(P＜0.05);B组患者单位麻醉时间内丙泊酚用量、单位手术时间内丙泊酚用量均明显高于A、C组,差异均有统计学意义(P＜0.05).(3)血流动力学:A组T2、T3时平均动脉压均高于B组、C组,A组T4时的平均动脉压更加接近于T0;3组患者不同时刻心率差异无统计学意义(P＞0.05);A组T2、T3时BIS值均低于B组、C组,差异均有统计学意义(P＜0.05).(4)术后恢复情况:A组患者PACU停滞时间、自主呼吸恢复时间、指令反应恢复时间均明显低于B、C组,差异均有统计学意义(P＜0.05).(5)术后谵妄:A组患者术后谵妄发生率为16.67％,显著低于B、C组(40.00％、46.67％),差异均有统计学意义(P＜0.05).结论 老年髋关节置换术中采用丙泊酚靶控输注麻醉可减少丙泊酚用量,术中生命体征更加平稳,可降低人工操作次数,术后麻醉苏醒更快,且术后谵妄发生率也更低,是老年患者首选的麻醉方案.
Abstract
Objective To investigate the effect of propofol closed loop target controlled infusion anesthesia in elderly patients with total hip arthroplasty and its impact on the risk of postoperative delirium.Methods A total of 90 elderly patients with hip fractures who received treat-ment at Anqing First People's Hospital from January 2020 to January 2023 were scheduled to undergo hip replacement surgery,and divided into the group A,group B,and group C based on different anesthesia methods,with 30 cases in each group.The group A was given closed loop target con-trolled continuous infusion anesthesia with propofol,and group B was given open loop target controlled continuous infusion anesthesia with propo-fol,and group C was given propofol artificial continuous infusion anesthesia.The intraoperative data(anesthesia time,surgical time,and extuba-tion time),anesthesia related indicators(total intraoperative propofol consumption and the adjustment times of maintenance pump),hemodynamic changes[mean arterial pressure,heart rate,and bispectral index(BIS)values for anesthesia induction start(T0),intubation(T1),surgery start(T2),surgery end(T3),extubation(T4)],postoperative recovery,and postoperative delirium were compared among the three groups.Results(1)Intraoperative data:theere were no statistically significant differences in anesthesia time,surgical time,and extubation time among the three groups of patients(P＞0.05).(2)Anesthesia related indicators:the total intraoperative propofol consumption and the adjustment times of main-tenance pump in group A were significantly lower than those in groups B and C,and the differences were statistically significant(P＜0.05);the dosage of propofol per unit of anesthesia time and per unit of surgical time in group B patients were significantly higher than those in groups A and C,and the differences were statistically significant(P＜0.05).(3)Hemodynamics:the average arterial pressure of group A at T2 and T3 was higher than that of groups B and C,and the differences were statistically significant(P＜0.05);the average arterial pressure of group A at T4 was closer to T0.There was no statistically significant difference in heart rate among the three groups of patients at different times(P＞0.05).The BIS values of group A at T2 and T3 were lower than those of groups B and C,and the differences were statistically significant(P＜0.05).(4)Postoperative recovery:the PACU stagnation time,spontaneous respiration recovery time and command response recovery time in group A were significantly lower than those in group B and C,and the differences were statistically significant(P＜0.05).(5)Postoperative delirium:the in-cidence of postoperative delirium in group A was 16.67％,which was significantly lower than that in groups B and C(40.00％,46.67％),and the differences were statistically significant(P＜0.05).Conclusion Target controlled infusion anesthesia with propofol can reduce the amount of propofol,the intraoperative vital signs are more stable,the number of manual operations is reduced,the postoperative anesthesia recovery is fas-ter,and the incidence of postoperative delirium is lower,so it is the first choice for elderly patients
基金项目
安徽省卫生健康委科研项目(AHWJ2021b103)
维普
万方数据