不同全身麻醉药物在老年患者关节置换术中的麻醉效果分析

Anesthesia effect comparison of different general anesthetics in joint replacement of elderly patients

目的探讨不同全身麻醉药物在老年患者关节置换术中的麻醉效果。方法选取本院收治的90例行关节置换术的老年患者(>60岁)为研究对象,随机分为A、B组,每组各45例。A组患者采用瑞芬太尼和丙泊酚静脉注射维持麻醉深度,B组患者采用七氟烷和瑞芬太尼静息复合麻醉维持麻醉深度。比较两组患者不同时点的血流动力学、吞咽恢复时间、术后清醒时间、拔管时间、出麻醉恢复室(PACU)时间以及简易精神状态量表(MMSE)评分。结果两组患者麻醉前和手术开始时的平均动脉压(MAP)和心率(HR)比较均无显著差异(P>0.05),术中30分钟和术毕MAP和HR比较差异均具有显著性(P<0.05)。两组患者吞咽恢复时间、术后清醒时间、拔管时间和出PACU时间比较差异均具有显著性(P<0.05)。两组患者MMSE评分比较差异具有显著性(χ2=9.301,P<0.05)。结论丙泊酚静脉全身麻醉能够更好地维持患者术中的血流动力学稳定,术后苏醒较快,认知功能良好,可以更好地应用于老年患者关节置换术中。

Objective To explore the anesthesia effect of different general anesthetics in joint replacement in elderly patients. Method 90 patients elderly over the age of 60 were divided into group A and group B, 45 cases for each. Group A： fentanyl and propofol intravenous anesthesia depth of anesthesia. Group B： sevoflurane and fentanyl resting compound anesthesia maintained anesthesia depth, different point of hemodynamics, swallowing recovery time and postoperative awake time, extubation time and the PACU time and MMSE score were compared between the two groups. Result Mean arterial pressure（MAP） and heart rate（HR） were not statistically different between the two groups before anesthesia and at the beginning of surgery（P〉0.05）. There were statistically differences in MAP and HR in 30 minutes during operation and after operation between the two groups（P〈0.05）. There were statistically differences in swallowing recovery time, postoperative awake time, extubation time and the PACU time between the two groups（P〈0.05）. MMSE score were statistical differences between the two groups（χ^2= 9.301, P〈0.05）. Conclusion Patients with propofol intravenous anesthesia maintain better hemodynamics, patient wake up faster, and have better postoperative cognitive function, which would be better used in elderly patients with joint replacement.