舒芬太尼复合丙泊酚全凭静脉麻醉对老年骨科手术患者血流动力学、VAS评分及认知功能的影响

Effect of sufentanil combined with propofol for total intravenous anesthesia on hemodynamics,VAS score and cognitive function in elderly patients undergoing orthopedic surgery

目的:探讨舒芬太尼复合丙泊酚全凭静脉麻醉对老年骨科手术患者血流动力学、VAS评分及认知功能的影响。方法:选取2017年1月~2018年1月本院收治的70例老年骨科手术患者为研究对象,依据患者入院顺序奇偶数编号分为对照组和实验组各35例,对照组采用丙泊酚进行麻醉诱导,实验组实施舒芬太尼复合丙泊酚全凭静脉麻醉,对比两组诱导插管(T1)、进胸时(T2)、拔管后10 min(T3)监测两组平均动脉压(MAP)、HR、血氧饱和度(SpO2)水平、围术期视觉模拟疼痛评分(VAS)、认知功能[采用简易精神状态量表(MMSE)评分评估]及自主呼吸恢复时间、睁眼时间、拔管时间。结果:T1时两组MAP、HR、SpO2相较无明显差异;T2、T3实验组MAP、HR降低较对照组明显,但两组SpO2相较无明显差异;术前两组VAS评分、MMSE评分相较无明显差异;术后1、24、48h实验组VAS评分较对照组明显低,术后3、6、24h实验组MMSE评分明显高于对照组;实验组自主呼吸恢复时间、睁眼时间、拔管时间明显短于对照组。结论:舒芬太尼复合丙泊酚全凭静脉麻醉可有效稳定老年骨科手术患者血流动力学、降低VAS评分、减轻其认知功能障碍,同时明显缩短患者麻醉后恢复时间。

Objective To investigate the effect of sufentanil combined with propofol for total intravenous anesthesia on hemodynamics,VAS score and cognitive function in elderly patients undergoing orthopedic surgery.Methods A total of 70 elderly patients undergoing orthopedic surgery in the hospital during the period from January 2017 to January 2018 were selected as study subjects.They were divided into the control group and the experimental group according to the odd and even number of admission,35 patients in each group.The control group was treated with propofol for anesthesia induction,and the experimental group was treated with sufentanil combined with propofol for total intravenous anesthesia.The mean arterial pressure(MAP),heart rate(HR)and blood oxygen saturation(SpO2)monitored at induction of intubation(T1),insertion to the chest(T2)and 10 min after extubation(T3),perioperative pain visual analogue scale(VAS)scores,cognitive function[Mini-Mental State Examination(MMSE)score],spontaneous breathing recovery time,eye-opening time and extubation time were compared between the two groups.Results There was no significant difference in MAP,HR or SpO2 between the two groups at T1.The decrease of MAP and HR in the experimental group at T2 and T3 was more obvious than that in the control group,but there was no significant difference in SpO2 between the two groups.There was no significant difference in VAS scores or MMSE scores between the two groups before operation.VAS scores of the experimental group were significantly lower than those of the control group at 1 hour,24 hours and 48 hours after the operation,and the MMSE score was significantly higher than that of the control group at 3,6 and 24 hours after the operation.The spontaneous breathing recovery time,eye-opening time and extubation time in the experimental group were significantly shorter than those in the control group.Conclusion Sufentanil combined with propofol for total intravenous anesthesia can effectively stabilize hemodynamics,decrease the VAS score,relieve cognitive impairment and significantly shorten the recovery time from anesthesia of elderly patients undergoing orthopedic surgery.