低剂量丙泊酚静脉麻醉复合局部浸润麻醉对老年髋关节骨折患者的影响

Effect of Low Dose Propofol Intravenous Anesthesia Combined with Local Infiltration Anesthesia on Elderly Patients with Hip Joint Fracture

目的:观察低剂量丙泊酚静脉麻醉复合局部浸润麻醉在老年髋关节骨折患者中的应用效果。方法:选取2019年2月-2020年2月张掖市甘州区人民医院进行手术治疗的96例老年髋关节骨折患者。根据掷硬币法将其分为观察组(n=48)与对照组(n=48)。对照组给予全麻,观察组给予低剂量丙泊酚静脉麻醉复合局部浸润麻醉。比较两组麻醉前及麻醉后2 h应激指标,麻醉效果,术前及术后的认知功能、呼吸循环指标。结果:与麻醉前相比,麻醉后2 h两组超氧化物歧化酶水平降低,丙二醛、白细胞介素-2、白细胞介素-1β水平升高(P<0.05);麻醉后2 h,观察组丙二醛、白细胞介素-2、白细胞介素-1β水平均低于对照组,超氧化物歧化酶水平高于对照组(P<0.05)。观察组麻醉药物总剂量多于对照组(P<0.05),但两组睁眼时间、麻醉复苏室观察时间、术中液体输注量比较差异均无统计学意义(P>0.05)。术后,两组的简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分均下降,观察组MMSE、MoCA评分高于对照组(P<0.05)。术后,两组心率、平均动脉压及血氧饱和度比较差异均无统计学意义(P>0.05)。结论:全麻与低剂量丙泊酚静脉麻醉复合局部浸润麻醉应用于老年髋关节骨折患者中均有较好的麻醉效果,但是相对于全麻,低剂量丙泊酚静脉麻醉复合局部浸润麻醉对患者术后认知功能的影响更轻微,同时能减轻患者的应激反应。

Objective:To observe the application effects of low dose of Propofol intravenous anesthesia combined with local infiltration anesthesia in elderly patients with hip joint fracture.Method:From February 2019 to February 2020,96 elderly patients with hip joint fracture were selected for surgical treatment in Zhangye Ganzhou District People’s Hospital.They were divided into observation group(n=48)and control group(n=48)according to coin toss method.The control group was given general anesthesia,and the observation group was given low dose Propofol intravenous anesthesia combined with local infiltration anesthesia.The stress index before and 2 h after anesthesia,anesthetic effect,preoperative and postoperative cognitive function,respiratory and circulatory indexes were compared between the two groups.Result:Compared with before anesthesia,superoxide dismutase level was decreased,malondialdehyde,interleukin-2 and interleukin-1βlevels were increased 2 h after anesthesia in the two groups(P<0.05).At 2 h after anesthesia,the levels of malondialdehyde,interleukin-2 and interleukin-1βin the observation group were lower than those in the control group,and the level of superoxide dismutase was higher than that in the control group(P<0.05).The total dose of anesthetic drugs in the observation group was greater than that in the control group(P<0.05),but there were no significant differences in eye opening time,observation time in anesthesia resuscitation room and intraoperative fluid infusion volume between the two groups(P>0.05).After operation,the scores of the mini-mental state examination(MMSE)and the Montreal cognitive assessment scale(MoCA)decreased in both groups,and the MMSE and MoCA scores in the observation group were higher than those in the control group(P<0.05).After operation,there were no significant differences in heart rate,mean arterial pressure and blood oxygen saturation between the two groups(P>0.05).Conclusion:General anesthesia and low dose Propofol intravenous anesthesia combined with local infiltration anesthesia have better anesthetic effects in elderly patients undergoing hip joint fracture.However,compared with general anesthesia,low dose Propofol intravenous anesthesia combined with local infiltration anesthesia has less impact on the postoperative cognitive function of patients,and can reduce the stress response of patients.