闭环靶控输注丙泊酚对老年髋关节置换术患者心血管应激反应的影响

Effects of propofol through closed-loop target-controlled infusion on cardiovascular stress response in elderly patients undergoing hip arthroplasty

目的:分析闭环靶控输注(target-controlled infusion,TCI)丙泊酚对老年髋关节置换术患者心血管应激反应的影响。方法:选取2019年8月至2020年8月于新疆医科大学第一附属医院行髋关节置换术的老年患者240例;2019年8月至2020年2月入组患者为A组(n=114),采用丙泊酚闭环TCI;2020年3月至2020年8月入组患者为B组(n=126),采用丙泊酚手控输注。比较两组围手术期相关指标、疼痛评分[视觉模拟疼痛评分(Visual Analogue Scale,VAS)]、心血管应激反应[收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)]、炎症反应[白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)]及术后并发症发生情况。结果:两组手术时间和术中出血量比较,差异无统计学意义(P>0.05),A组丙泊酚用量、苏醒时间、拔管时间均明显少于B组(P<0.05),VAS评分明显低于B组(P<0.05);不同时间A组DBP、SBP及HR变化幅度小于B组(P<0.05);不同时间A组IL-6、TNF-α水平变化幅度优于B组(P<0.05);A组并发症总发生率明显低于B组(4.39%vs 12.70%,P<0.05)。结论:针对老年髋关节置换术患者,采用丙泊酚闭环TCI麻醉可减少丙泊酚的用量,有利于患者术后恢复,术后疼痛较轻,可减轻因手术带来的应激反应和炎症反应,并发症少。

Objective:To analyze the effects of propofol through closed-loop target-controlled infusion(TCI)on cardiovascular stress response in elderly patients undergoing hip arthroplasty.Methods:A total of 240 elderly patients who underwent hip replacement in our hospital from August 2019 to August 2020 were selected.Patients enrolled from August 2019 to February 2020 were assigned into group A(n=114,propofol using closed-loop TCI)and patients enrolled from March 2020 to August 2020 were assigned into group B(n=126,propofol by manual infusion).The perioperative related indexes,pain score[Visual Analog Scale(VAS)],cardiovascular stress response[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)],inflammatory response[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]and postoperative complications were compared between the two groups.Results:There were no significant differences in operation time and intraoperative blood loss between the two groups(P>0.05).The amount of propofol,recovery time,and extubation time in group A were significantly less than those in group B(P<0.05).VAS score was significantly lower than that of group B(P<0.05).At different times,the changes in DBP,SBP and HR in group A were smaller than those in group B(P<0.05).The changes in IL-6 and TNF-αlevels in group A were smaller than those in group B at different times(P<0.05).The total incidence of complications in group A was significantly lower than that in group B Group(4.39%vs 12.70%,P<0.05).Conclusion:For elderly patients undergoing hip replacement,the propofol via closed-loop TCI anesthesia can reduce the dosage of propofol,accelerate the postoperative recovery of patients,and reduce the stress and inflammation caused by surgery,with fewer complications.