SPI指导镇痛在老年患者PFNA中的应用研究

Study on the application of SPI-guided analgesia in elderly patients with PFNA

目的探讨手术体积描记指数(SPI)指导镇痛对行股骨近端防旋髓内钉固定术(PFNA)老年患者术中血流动力学变化及术后恢复质量的影响。方法60例择期于全身麻醉下行PFNA的老年患者接受SPI指导镇痛或依据心率血压指导镇痛,分为SPI组和对照组,每组各30例,记录并比较两组术中心率和血压值、术后24 h 40项恢复质量量表(QoR-40)评分、苏醒时长、拔管后1 min、出恢复室时疼痛评分及苏醒期躁动、恶心、呕吐、寒战发生率。结果与对照组比较,SPI组术后24 h QoR-40量表评分更高[(129.57±34.28)分vs.(153.07±33.58)分]、术中瑞芬太尼用量更少[(1.29±1.13)mg vs.(0.63±0.18)mg]、全身麻醉苏醒时长更短[(17.93±6.26)min vs.(13.63±3.10)min],差异有统计学意义(P<0.05)。结论SPI指导镇痛可改善老年患者PFNA术后24 h恢复质量。

Objective To investigate the effect of surgical pleth index(SPI)guided analgesia on intraoperative hemodynamic changes and postoperative recovery quality in elderly patients undergoing proximal femoral nail antirotation(PFNA).Methods A total of 60 elderly patients undergoing elective PFNA in general anesthesia were divided into the SPI group(n=30)and the control group(n=30).The heart rate and blood pressure values during surgery,quality of recovery-40(QoR-40)score at 24 h after operation,the awake duration,the pain score at 1 min after extubation and discharge from post-anesthesia recovery unit,the incidence of emergence agitation,nausea,vomiting,and shivering were measured and recorded.Results Compared with the control group,the SPI group had higher QoR-40 scores at 24 h after surgery[(129.57±34.28)points vs.(153.07±33.58)points],and less intraoperative remifentanil dosage[(1.29±1.13)mg vs.(0.63±0.18)mg]and shorter recovery time from general anesthesia[(17.93±6.26)min vs.(13.63±3.10)min],the difference was statistically significant(P<0.05).Conclusion SPI guided analgesia during PFNA in elderly patients would improve postoperative recovery quality 24 h after surgery.