脑电双频谱指数指导下七氟烷吸入复合静脉麻醉对老年股骨颈骨折患者应激反应、苏醒质量及认知功能的影响

Effects of EEG bispectral index-guided sevoflurane inhalation combined with intravenous anesthesia on stress response,recovery quality and cognitive function in elderly patients with femoral neck fracture

目的观察脑电双频谱指数(BIS)指导下七氟烷吸入复合静脉麻醉对老年股骨颈骨折患者应激反应、苏醒质量及认知功能的影响。方法回顾性分析2022年1月—2024年3月在江油市人民医院行人工髋关节置换术的113例老年股骨颈骨折患者临床资料,根据麻醉方案分为对照组(n=53,BIS指导下全凭静脉麻醉)和观察组(n=60,BIS指导下七氟烷吸入复合静脉麻醉)。比较2组应激反应[收缩压(SBP)、舒张压(DBP)、心率(HR)、皮质醇(Cor)水平、丙二醛(MDA)水平]、苏醒质量(自主呼吸恢复时间、定向力恢复时间、苏醒时间)、认知功能、视觉模拟评分(VAS法)及并发症发生情况。结果2组插管即刻(T1)、切皮后10 min(T2)、手术结束时(T3)的SBP、DBP、HR较麻醉诱导前(T0)降低(均P<0.05),但观察组T1、T2、T3时SBP、DBP、HR显著高于对照组,差异均有统计学意义(均P<0.05);2组术后即刻、术后24 h、术后72 h的Cor、MDA水平较术前升高,但观察组术后即刻、术后24 h、术后72 h的Cor、MDA水平显著低于对照组,差异均有统计学意义(均P<0.05);观察组自主呼吸、定向力恢复和苏醒时间短于对照组(P<0.05);观察组术后12 h MMSE得分高于对照组(P<0.05);观察组术后4、6、12、24h的VAS评分均低于对照组(均P<0.05);2组并发症发生率差异无统计学意义(P>0.05)。结论BIS指导下七氟烷吸入复合静脉麻醉可减轻老年股骨颈骨折手术患者术中应激反应,提高苏醒质量,改善术后认知功能,缓解术后疼痛,具有一定的临床应用价值。

Objective To observe the effects of EEG bispectral index(BIS)-guided sevoflurane inhalation combined intravenous anesthesia on stress response,recovery quality and cognitive function in elderly patients with femoral neck fracture.Methods A retrospective analysis was conducted on the clinical data of 113 elderly patients with femoral neck fracture who underwent artificial femoral head replacement in People s Hospital of Jiangyou City between January 2022 and March 2024.According to different anesthetic method,the patients were divided into control group(n=53,BIS-guided total intravenous anesthesia)and observation group(n=60,BIS-guided sevoflurane inhalation combined intravenous anesthesia).The stress response[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),cortisol(Cor)and malonaldehyde(MDA)],recovery quality(recovery time of autonomous respiration,recovery time of directive force and awakening time),cognitive function,Visual Analogue Scale(VAS)score and complications were compared between the two groups.Results SBP,DBP and HR of both groups at immediate intubation(T1),10 min after skin incision(T2)and the end of operation(T3)were lower than those of the same group before anesthesia induction(T0)(all P<0.05),and the observation group was significantly higher than that of the control group(P<0.05).The levels of Cor and MDA immediately after surgery,24 h after surgery and 72 h after surgery of both groups were higher than those of the same group before surgery(all P<0.05),and the observation group was significantly lower than that of the control group(P<0.05).The recovery time of autonomous respiration,recovery time of directive force and awakening time of the observation group were shorter than those of the control group(P<0.05).MMSE scores of the observation group at 12 h after operation were higher than those of the control group(P<0.05).The VAS scores of the observation group at 4,6,12 and 24 h after surgery were lower than those of the control group(all P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion BIS-guided sevoflurane inhalation combined intravenous anesthesia can alleviate intraoperative stress reactions,improve recovery quality,improve postoperative cognitive function,and alleviate postoperative pain in elderly patients undergoing femoral neck fracture surgery.It has certain clinical application value.