氢吗啡酮结合丙泊酚闭环靶控输注用于老年全髋关节置换术的效果及对术后谵妄的影响

Effect of hydromorphone combined with propofol closed loop target controlled infusion in total hip replacement for elderly patients and its influence on postoperative delirium

目的探讨氢吗啡酮结合丙泊酚闭环靶控输注用于老年全髋关节置换术的效果及对术后谵妄的影响。方法本研究为前瞻性研究。抽取2019年9月至2022年8月河南中医药大学第五临床医学院进行全髋关节置换术治疗的120例患者作为研究对象,采用随机数字表法将120例患者分为研究组和对照组,每组60例。研究组采取氢吗啡酮结合丙泊酚闭环靶控输注进行麻醉,对照组采取氢吗啡酮进行麻醉。比较两组的镇痛以及镇静作用、谵妄评定法评分以及谵妄发生率。结果在静息状态以及活动状态,两组术后1、4 h视觉模拟评分法(VAS)评分比较差异未见统计学意义(P>0.05);术后12、24 h,研究组在静息状态及活动状态的VAS评分均低于对照组(P均<0.05)。术后1、4 h,两组Ramsay镇静评分比较差异未见统计学意义(P>0.05);术后12、24 h,研究组Ramsay镇静评分低于对照组(P<0.05)。术后1 h,两组谵妄评定法(CAM)评分比较差异未见统计学意义(P>0.05);术后4、12、24 h,研究组CAM评分低于对照组(P<0.05)。研究组谵妄发生率(10.00%,6/60)低于对照组(25.00%,15/60),P<0.05。结论老年患者全髋关节置换术中采取氢吗啡酮结合丙泊酚闭环靶控输注,患者的镇痛及镇静作用显著,对于减少术后谵妄具有积极意义。

Objective To investigate the effect of hydromorphone combined with propofol closed loop target controlled infusion in total hip replacement for elderly patients and its influence on postoperative delirium.Methods This study was a prospective trail.A total of 120 patients who underwent total hip replacement in the Fifth Clinical Medical College of Henan University of Chinese Medicine from September 2019 to August 2022 were selected as research objects.And they were divided into study group and control group by random number table method,with 60 cases in each group.Patients in the study group were anesthetized with hydromorphone combined with propofol closed-loop target controlled infusion,while patients in the control group were anesthetized with hydromorphone.The analgesic and sedative effects,delirium assessment scores and incidence of delirium were compared between the two groups.Results At resting state and activity state,there was no significant difference in visual analogue scale(VAS)score at 1 and 4 hours after surgery between the two groups(P>0.05);however,VAS scores at resting state and activity state at 12 and 24 hours after surgery in the study group were significantly lower than those in the control group(all P<0.05).There was no significant difference in Ramsay sedation score between the two groups at 1 and 4 hours after surgery(P>0.05),however,the Ramsay sedation scores in the study group were significantly lower than those in the control group at 12 and 24 hours after surgery(P<0.05).There was no significant difference in confusion assessment method(CAM)between the two groups at 1 h after surgery(P>0.05);CAM of the study group was significantly lower than that of the control group at 4,12 and 24 hours after surgery(P<0.05).The incidence of delirium in the study group(10.00%,6/60)was significantly lower than that in the control group(25.00%,15/60),P<0.05.Conclusions Hydromorphone combined with propofol closed loop target controlled infusion during total hip replacement in elderly patients has significant analgesic and sedative effects,which has positive significance for reducing postoperative delirium.