顺阿曲库铵静脉复合丙泊酚、瑞芬太尼对老年患者全髋关节置换术后认知功能和应激反应的影响

Effects of Cisatracurium Intravenous Combined with Propofol and Remifentanil on Cognitive Function and Stress Response in Elderly Patients after Total Hip Arthroplasty

目的 :探讨顺阿曲库铵静脉复合丙泊酚、瑞芬太尼对老年患者全髋关节置换术后认知功能和应激反应的影响。方法 :选取三亚市人民医院在2014年5月～2017年5月期间收治老年全髋关节置换术患者110例为研究对象。采用随机数字表法随机分为观察组(n=55)和对照组(n=55)。观察组麻醉诱导采用顺阿曲库铵+丙泊酚+瑞芬太尼+咪达唑仑,对照组麻醉诱导采用丙泊酚+瑞芬太尼+咪达唑仑。比较两组麻醉前(T0)、麻醉后5min(T1)、插管时(T2)、切皮时(T3)和拔管时(T4)血流动力学变化、术后认知功能、应激反应、麻醉情况及不良反应。结果 :在T2、T3、T4时,两组平均动脉压(MAP)水平显著降低,且观察组MAP水平显著低于对照组,在T2、T3、T4时,两组心率(HR)显著升高,但观察组HR显著低于对照组;术后1h,观察组简易智力状态检查量表(MMSE)评分为(28.08±1.43)分,显著高于对照组的(26.87±1.83)分,观察组血清皮质醇水平为(442.19±57.24)nmol/L,显著低于对照组的(535.28±73.27);观察组起效时间和作用时间分别为(1.74±0.63)min和(32.64±10.05)min,显著短于对照组;观察组总不良反应发生率为5.45%,显著低于对照组的18.18%。结论 :顺阿曲库铵静脉复合丙泊酚、瑞芬太尼用于老年全髋关节置换术麻醉,麻醉起效快、术后苏醒快,术中和术后应激反应小,利于患者术后认知功能恢复,且安全有效。

Objective To explore the effects of cisatracurium intravenous combined with propofol and remifentanil on stress response and cognitive function in elderly patients after total hip arthroplasty.Methods 110 cases of patients with total hip arthroplasty treated in Yuechi People’s Hospital from May 2014 to May 2017 were selected for the study and divided into the observation group(n=55)and the control group(n=55)and control group(n=55)according to the random number table method.The anesthesia in the observation group was induced by cisatracurium and propofol,remifentanil and midazolam,and the control group was given anesthesia induction with propofol,remifentanil and midazolam.The hemodynamic changes,postoperative cognitive function,stress response,anesthesia and adverse reactions were compared between the two groups before anesthesia(T0),5 min after anesthesia(T1),at intubation(T2),at skin incision(T3)and at extubation(T4).Results At the time point of T2,T3 and T4,the level of mean arterial pressure(MAP)was significantly decreased,and the MAP level in the observation group was significantly lower than that in the control group.At the time point of T2,T3 and T4,the heart rate(HR)of the two groups was significantly increased,and HR was significantly lower in the observation group than that in the control group at the time point of T2,T3 and T4.The Mini-Mental State Examination(MMSE)score was(28.08±1.43)points in the observation group,which was significantly higher than that of the control group with(26.87±1.83)points,and the level of serum cortisol was(442.19±57.24)nmol/L in the observation group,which was significantly lower than that of the control group with(535.28±73.27).The onset time and action time of the observation group were(1.74±0.63)min and(32.64±10.05)min,which were significantly shorter than those of the control group.The incidence rate of adverse events was 5.45%in the observation group,which was significantly lower than that in the control group with 18.18%.Conclusion Cisatracurium intravenous combined with propofol and remifentanil can have a quick anesthesia and quick postoperative recovery with little intraoperative and postoperative stress responses for the anesthesia in elderly patients with total hip arthroplasty,which is helpful for postoperative cognitive function recovery of patients with safety and effectiveness.