BIS监测下麻醉对老年骨折手术患者术后认知功能障碍和谵妄的影响

Effects of anesthesia under BIS monitoring on postoperative cognitive dysfunction and delirium in elderly patients taking fracture surgery

目的探讨BIS监测下麻醉对老年骨折手术患者术后认知功能障碍和谵妄的影响。方法回顾性分析本院2014年7月至2017年1月收治的老年骨折患者80例临床资料，按照麻醉监测方式分为对照组（n=40）和观察组（n=40），对照组患者根据麻醉师经验和患者表现调整麻醉深度，观察组患者根据BIS监测值调整麻醉深度，比较两组患者术中异丙酚与舒芬太尼使用量，术后认知功能障碍和谵妄情况。结果观察组患者术中异丙酚与舒芬太尼用量分别为（495．74±52．11）mg、（0．92±0．18）mg，均明显少于对照组的（601．29±78．96）mg、（1．41±0．27）mg（均P〈0．05）；手术前1d和术后第1d，两组患者MMSE评分差异均无统计学意义（均P〉0．05）；术后第5d观察组患者MMSE评分为（23．49±2．50）分，显著高于对照组的（21．75±2．16）分（P〈0．05）；观察组患者术后谵妄发生率为10．0％，显著低于对照组的27．5％（P〈0．05）。结论BIS监测下麻醉可减轻老年骨折手术患者术后认知功能障碍，减少谵妄发生。

Objective To explore the effects of anesthesia under BIS monitoring on postoperative cognitive dysfunction and delirium in elderly patients taking fracture surgery. Methods The clinical data of 80 elderly patients taking fracture treated at our hospital from July, 2014 to January, 2017 were retrospectively analyzed. And the patients were divided into a control group （n=40） and an observation group （n=40） according to anesthesia monitoring methods. The control group were adjusted the anesthesia depth according to the anesthesiologist s＇ experience of and the patients＇ manifestation and the observation group according to the BIS monitoring value. The usages of propofol and sufentanil during operation, postoperative cognitive dysfunction, and delirium were compared between the two groups. Results The usages of propofol and sufentanil were significantly lower in the observation group than in the control group [（495.74±52.11）mg vs. （601.29±78.96）mg and （0.92±0.18）mg vs. （1.41±0.27）mg, P〈0.05]. There were no statistical differences in MMSE scores between the two groups 1 d before and 1 d after the operation （P〉0.05）. The MMSE score was significantly higher in the observation group than in the control group 5 d after operation [（23.49±2.50） vs. （21.75±2.16）, P〈0.05]. The incidence of postoperative delirium was significantly lower in the observation group than in the control group （10.0% vs. 27.5%） （P〈0.05）. Conclusion Anesthesia under BIS monitoring for elderly patients taking fracture surgery can reduce the postoperative cognitive dysfunction and the incidence of delirium.