丙泊酚静脉全麻复合腰硬联合麻醉对老年髋关节骨折手术患者血流动力学和预后康复的影响

Effect of Propofol Intravenous General Anesthesia Combined with Lumbar Epidural Anesthesia on Hemodynamics and Prognosis Recovery in Elderly Patients undergoing Hip Fracture Surgery

目的探讨老年髋关节骨折手术患者应用丙泊酚静脉全麻复合腰硬联合麻醉的效果。方法选取该院2022年11月—2023年11月接收的86例老年髋关节骨折手术患者为研究对象,采用随机数字表法将其分为对照组和观察组,各43例。对照组采用腰硬联合麻醉,观察组采用丙泊酚静脉全麻复合腰硬联合麻醉。对比两组麻醉优良率、围手术期血流动力学、术后恢复时间、术后疼痛、认知功能。结果观察组老年患者麻醉优良率为97.67%,高于对照组的81.40%,差异有统计学意义(P<0.05)。麻醉前,两组平均动脉压(MAP)、心率(HR)比较,组间差异无统计学意义(P>0.05);麻醉后10 min、麻醉后30 min、术毕时,观察组MAP、HR水平与麻醉前比较,差异无统计学意义(P>0.05);对照组MAP、HR水平均高于麻醉前,且观察组MAP、HR水平均低于对照组,差异有统计学意义(P<0.05)。观察组术后自主呼吸恢复时间、麻醉后监测治疗室(PACU)留观时间、呼之睁眼时间与对照组比较,组间差异无统计学意义(P>0.05);术后2 h、12 h,观察组疼痛视觉模拟评分均低于对照组,组间差异有统计学意义(P<0.05)。术前,两组蒙特利尔认知评估量表(MoCA)评分比较,差异无统计学意义(P>0.05);术后第1天、术后第3天,两组MoCA评分均低于术前,且观察组MoCA评分均高于对照组,差异有统计学意义(P<0.05)。结论老年髋关节骨折患者手术治疗期间配合丙泊酚静脉全麻复合腰硬联合麻醉方案能够稳定术中血流动力学,减轻术后疼痛,改善术后认知功能,提升麻醉效果。

Objective To observe and explore the effect of propofol intravenous general anesthesia combined with spinal epidural anesthesia on perioperative hemodynamics and prognosis in elderly patients undergoing hip fracture surgery.Methods A total of 86 elderly patients who underwent hip fracture surgery at the hospital from November 2022 to November 2023 were selected as the research subjects.They were randomly divided into a control group and an observation group using a random number table method,with 43 cases in each group.The control group received combined spinal epidural anesthesia,while the observation group received propofol intravenous general anesthesia combined with spinal epidural anesthesia.The anesthesia excellence rate,perioperative hemodynamics,postoperative recovery time,postoperative pain,and cognitive function were compared between the two groups.Results The excellent anesthesia rate of elderly patients in the observation group was 97.67%,which was higher than 81.40%in the control group,and the difference was statistically significant(P<0.05).Before anesthesia,there were no statistically significant differences in mean arterial pressure(MAP)and heart rate(HR)between the two groups(P>0.05);there was no statistically significant difference in the levels of MAP and HR in the observation group at 10 minutes after anesthesia,30 minutes after anesthesia,and after surgery compared to before anesthesia(P>0.05);the control group had higher levels of MAP and HR at 10 minutes after anesthesia,30 minutes after anesthesia,and after surgery compared to before anesthesia,and the observation group had lower levels of MAP and HR at 10 minutes after anesthesia,30 minutes after anesthesia,and after surgery compared to the control group,with a statistically significant difference(P<0.05).There were no statistically significant differences between the observation group and the control group in terms of postoperative spontaneous breathing recovery time,postoperative monitoring and treatment roomobservation time,and eye opening time after breathing(P>0.05);at 2 and 12 hours after surgery,the pain Visual Analog Scale score of the observation group were lower than those of the control group,and the differences between the groups were statistically significant(P<0.05).Before surgery,there was no statistically significant difference in the scores of the Montreal Cognitive Assessment Scale(MoCA)between the two groups(P>0.05);on the 1st and 3rd day after surgery,the MoCA scores of both groups were lower than before surgery,and the MoCA scores of the observation group were higher than those of the control group,with statistical significance(P<0.05).Conclusion During the surgical treatment of elderly hip fracture patients,the combination of propofol intravenous general anesthesia and lumbar epidural anesthesia can stabilize intraoperative hemodynamics,reduce postoperative pain,improve postoperative cognitive function,enhance anesthesia effectiveness.