不同麻醉深度与老年骨科手术患者术后认知功能障碍的相关性研究

Correlation between Different Depths of Anesthesia and Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Orthopaedic Surgery

[目的]观察全凭静脉麻醉下老年骨科手术患者维持不同麻醉深度与发生术后认知功能障碍（POCD）的相关性,探究最适合患者的脑电双频指数（BIS）监测区间.[方法]择期行全凭静脉麻醉下骨科手术老年患者120例,随机分为A组（BIS值41-50）和B组（BIS值51-60）.麻醉方式均为丙泊酚＋瑞芬太尼＋维库溴铵复合麻醉,通过调控丙泊酚及瑞芬太尼血浆靶控浓度,使患者麻醉深度维持在预定范围内,观察比较两组手术指标、麻醉效果、各时间点简易精神状态量表（MMSE）评分及不良反应发生率.[结果]两组术前（T0）、切皮时（T1）、骨折探查时（T2）、术毕（T3）各时间点心率（HR）、平均动脉压（MAP）比较差异无显著性（P〉0.05）;两组丙泊酚靶控浓度比较差异无显著性（P〉0.05）;A组瑞芬太尼靶控浓度高于B组（P〈0.05）,苏醒时间及拔管时间长于B组（P〈0.05）;术后2 h、d1两组MMSE评分均较术前1 d下降（P〈0.05）,且A组较B组下降显著（P〈0.05）;术后2 h、d1 A组POCD发生率高于B组（P〈0.05）;术后d3、d7两组POCD发生率比较差异无显著性（P〉0.05）;两组不良反应发生率比较差异无显著性（P〉0.05）.[结论]BIS值51-60能显著降低老年骨科手术患者术后2 h和术后d1的POCD发生率.

[Objective]To observe the correlation between different depths of anesthesia and postoperative cognitive dysfunction （POCD） in elderly patients undergoing orthopaedic surgery, and to find the most suitable bispectral index （BIS） monitoring interval under total intravenous anesthesia for elderly patients. [Meth- odslA total of 120 elderly patients undergoing orthopedic surgery under total intravenous anesthesia were randomly divided into group A （BIS value of 41-50） and group B （BIS value of 51-60）. The anesthesia method for all patients was propofol combined with remifentanil and vecuronium bromide. By adjusting the plasma concentration of propofol and remifentanil,the patient＇s anesthesia depth was maintained within the predeter- mined range. Surgical indexes, anesthesia effects MMSE scores at different time points, and the incidence of adverse reactions were compared between the two groups.[ResultslThere were no significant differences between the two groups in HR or MAP before surgery （To）, at skin incision （T1）, at fracture exploration （T2） or at the end of surgery （T3） （ P〉0.05）. There was no significant difference in the target concentration of propofol between the two groups （ P 〉0.05）, while the target concentration of remifentanil was higher in group A than in group B （ P〈0.05）. The recovery time and extubation time of group A were longer than those of group B （ P 〈0.05）. The MMSE scores of both groups at 2h and dl after surgery were lower than those at da before surgery （ P 〈0.05）, and the scores of group A were significantly lower than group B （ P -- 0.05）. The incidence rates of POCD in group A at 2h and dl after surgery were higher than group B （ P〈0.05）. There was no significant difference in the incidence of POCD between the two groups on the da or de af- ter surgery （ P〉0.05）. There was no difference in the incidence of adverse reactions between the two groups （ P 〉0.05）. [ConclusionlThe BIS value （51-60） can significantly reduce the incidence of POCD in elderly patients at 2h and d1 after orthopaedic surgery.