不同丙泊酚靶控输注法复合右美托咪定对单膝关节置换术老年患者的影响

Effects of Different Propofol Target Controlled Infusion Methods Combined with Dexmedetomidine in Elderly Patients with Single Knee Arthroplasty

目的分析不同丙泊酚靶控输注法复合右美托咪定在单膝关节置换术老年患者中的应用效果。方法选取2021年1月—2022年6月于天津市宝坻区人民医院接受单侧膝关节置换术的72例老年患者,根据丙泊酚靶控输注法的差异分为观察组和对照组,各36例。观察组采用闭环靶控输注法,对照组采用经验靶控输注法泵注丙泊酚。分别于术前､术后24 h测量两组患者的炎性指标,包括瘤坏死因子-α(TNF-α)､C-反应蛋白(CRP)､白介素-6(IL-6)､白介素-1β(IL-1β)､白介素-10(IL-10)和白介素-8(IL-8)。对比两组在麻醉后10 min(T_(1))､拔除气管导管即刻(T_(2))和术后6 h(T_(3))时的心率(HR)与平均动脉压(MAP)。采用Ramsay评分评估两组患者入室和术毕时的镇静程度,比较两组躁动发作次数和术后至清醒相关指标时间,观察两组并发症发生情况。结果术后,两组TNF-α､CRP､IL-6､IL-1β､IL-10和IL-8水平均较术前升高,但观察组低于对照组,差异均有统计学意义(均P0.05);观察组T_(1)和T_(2)期呼吸频率均高于对照组,T_(1)和T_(3)期HR和MAP均高于对照组,PaCO_(2)均低于对照组,差异均有统计学意义(均P0.05)。结论对老年单膝关节置换术患者采用闭环靶控输注丙泊酚复合右美托咪定可抑制炎症反应,减轻手术应激,提高苏醒质量,安全性高,值得推广。

Objective To analyze the application effect of different propofol target-controlled infusion methods combined with dexmedetomidine in elderly patients undergoing unilateral knee arthroplasty.Methods Seventy-two elderly patients who underwent unilateral knee arthroplasty in Tianjin Baodi District People’s Hospital from January 2021 to June 2022 were selected and divided into the observation group and the control group according to the difference of propofol target-controlled infusion method,each with 36 cases.The observation group used the closed-loop target-controlled infusion method,and the control group used the empirical target-controlled infusion method to pump propofol.Inflammatory indexes,including tumour necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),interleukin-1β(IL-1β),interleukin-10(IL-10),and interleukin-8(IL-8),were measured in the two groups before and 24 h after surgery,respectively.Heart rate(HR)and mean arterial pressure(MAP)were compared between the two groups at 10 min after anaesthesia(T_(1)),at the immediate moment of removal of the tracheal tube(T_(2))and at 6 h postoperatively(T_(3)).Ramsay score was used to assess the degree of sedation at admission and at the end of the operation,and the number of manic episodes and the postoperative time to wakefulness-related indexes were compared between the two groups,and the occurrence of complications in the two groups was observed.Results Postoperatively,the levels of TNF-α,CRP,IL-6,IL-1β,IL-10 and IL-8 increased in both groups compared with the preoperative period,but were significantly lower in the observation group than in the control group(all P>0.05).The respiratory rate in the T_(1) and T_(2) period of the observation group was significantly higher than that of the control group,HR and MAP in the T_(1) and T_(3) period were significantly higher than that of the control group,and PaCO_(2)was significantly lower than that of the control group(all P>0.05).Conclusion The use of closed-loop target-controlled infusion of propofol combined with dexmedetomidine in elderly patients undergoing unilateral knee arthroplasty can inhibit inflammatory reactions,reduce surgical stress,and improve the quality of awakening.It is safe and worth promoting.