BIS指导静脉全身麻醉对老年合并慢性贫血的膝关节置换手术术后谵妄的影响

Effect of Bis Guided Intravenous General Anesthesia on Postoperative Delirium in Elderly Patients with Chronic Anemia Undergoing Knee Arthroplasty

目的:探讨脑电双频谱指数(BIS)指导静脉全身麻醉对老年合并慢性贫血的膝关节置换手术术后谵妄的影响。方法:选取2018年3月-2020年3月本院收治的80例行膝关节置换手术的老年合并慢性贫血患者进行分析,将其随机分为观察组40例与对照组40例,对照组给予常规静脉全身麻醉,观察组给予BIS指导下静脉全身麻醉,对比两组血流动力学指标、术中用药量、VAS评分、术后谵妄发生率。结果:两组麻醉前、麻醉后和手术1 h后CVP、SVV、SVI、CI、MAP、HR对比,差异均无统计学意义(P>0.05);两组术中顺式阿曲库铵、舒芬太尼和瑞芬太尼用量对比,差异均无统计学意义(P>0.05),观察组术中丙泊酚用量显著少于对照组(P<0.05);两组术后6、12、24、48 h VAS评分对比,差异均无统计学意义(P>0.05);观察组术后第1、2、3天谵妄发生率均低于对照组,但差异均无统计学意义(P>0.05),观察组谵妄总发生率为20.0%,明显低于对照组的60.0%(P<0.05)。结论:应用BIS指导静脉全身麻醉对老年合并慢性贫血的膝关节置换手术与传统麻醉相比对患者的血流动力学指标无不良影响,能在不影响麻醉效果的情况下,减少术中丙泊酚用量,从而减少患者术后谵妄情况的发生,安全有效,值得临床应用推广。

Objective:To investigate the effect of BIS guided intravenous general anesthesia on postoperative delirium in elderly patients with chronic anemia undergoing knee arthroplasty.Method:A total of80 elderly patients with chronic anemia who underwent knee arthroplasty in our hospital from March 2018 to March 2020 were selected for analysis.The patients were randomly divided into the observation group (n=40) and the control group (n=40).The control group was given conventional intravenous general anesthesia,while the observation group was given intravenous anesthesia under BIS guidance.Hemodynamic indexes,intraoperative drug dosage,VAS score and the incidence of postoperative delirium of two groups were compared.Result:The CVP,SVV,SVI,CI,MAP,HR indexes of two groups before anesthesia,after anesthesia and 1 h after operation were compared,there were no significant differences (P>0.05).The dosage of CIS Atracurium,Sufentanil and Remifentanil of two groups compared,there were no significant differences (P>0.05),and the dosage of Propofol in the observation group was significantly less than that in the control group (P<0.05).There were no significant differences in VAS score between two groups at 6,12,24 and 48 h after operation (P>0.05).The incidence of delirium in the observation group on the first,second and third day after operation were lower than those in the control group,but the differences were not significant (P>0.05),but the total incidence of delirium in the observation group was 20.0%,which was significantly lower than 60.0% in the control group (P<0.05).Conclusion:Compared with the traditional anesthesia,BIS guided intravenous general anesthesia has no adverse effect on hemodynamic indexes of elderly patients with chronic anemia undergoing knee arthroplasty.It can reduce the dosage of Propofol during the operation without affecting the anesthetic effect,so as to reduce the occurrence of postoperative delirium,which is safe and effective,and it is worthy of clinical application and promotion.