老年髋关节置换术中丙泊酚闭环靶控输注麻醉深度的影响

Influence of Closed-loop Target-controlled Infusion of Propofol on Anesthesia Depth during Elderly Hip Replacement

目的 探究老年髋关节置换术中丙泊酚闭环靶控输注麻醉深度的影响。方法 选取2021年1月—2024年3月安徽省第二人民医院收治的80例老年髋关节置换术患者资料进行回顾性分析,根据丙泊酚闭环靶控输注中脑电双频谱指数(BIS)区间将患者分为D组(BIS 40~49,43例)和L组(BIS 50~59,37例)。比较两组手术情况、术中血流动力学、丙泊酚用量、血管活性药使用率、苏醒情况、认知功能及谵妄发生情况。结果 两组手术时间、术中出血量、术中血流动力学比较,差异均无统计学意义(P>0.05);D组术中丙泊酚用量大于L组(P<0.05),血管活性药使用率高于L组(P<0.05);D组拔管时间长于L组(P<0.05);两组麻醉监护室滞留时间比较差异无统计学意义(P>0.05);术后3 d时D组简易认知评估量表得分低于L组(P<0.05),术后3 d内谵妄发生率高于L组(P<0.05)。结论 老年髋关节置换术中维持相对浅麻醉下丙泊酚闭环靶控输注,有助于术后尽快苏醒,避免认知功能损害,降低谵妄风险。

Objective To explore the influence of closed-loop target-controlled infusion of propofol during elderly hip replacement on anesthesia depth.Methods The data of 80 elderly patients with hip replacement in Anhui No.2 Provincial People Hospital were retrospectively analyzed from January 2021 to March 2024.According to the bispectral index(BIS)interval during propofol closed-loop target-controlled infusion,they were divided into group D(BIS of 40-49,43 cases)and group L(BIS of 50-59,37 cases).The surgical conditions,intraoperative hemodynamics,dosage of propofol,utilization rate of vasoactive drugs,recovery status,cognitive function and incidence rate of delirium were compared between groups.Results There was no significant difference between the two groups in surgical time,intraoperative bleeding and intraoperative hemodynamics(P>0.05).In group D,thedosage of propofol was greater than that in g roup L(P<0.05),and the utilization rate of vasoactive drugs was higher than that in group L(P<0.05);the extubation time in group D was longer than that in group L(P<0.05),and there was no significant difference in the duration of anesthesia care unit stay between the two groups(P>0.05);the simple cognitive assessment scale score in group D was lower than that in group L at 3 days after surgery(P<0.05),and the incidence of delirium within 3 days after surgery was higher than that in group L(P<0.05).Conclusion Closed-loop target-controlled infusion of propofol under relatively light anesthesia maintenance during hip replacement in elderly patients is helpful for early postoperative recovery,and can avoid cognitive impairment and reduce the risk of delirium.