老年髋关节置换术患者全麻术后认知功能障碍与脑动-静脉氧含量差值相关性分析  

Correlation between postoperative cognitive dysfunction and brain arteriovenous oxygen content difference after general anesthesia in elderly patients with hip replacement

作　　者：许彬 宋珍 盛新安 刘林芝 杨婷 XU Bin;SONG Zhen;SHENG Xin’an;LIU Linzhi;YANG Ting(Department of Anesthesiology,Chang’an Hospital,Xi’an 710016,China)

机构地区：[1]长安医院麻醉科,陕西西安710016

出　　处：《陕西医学杂志》2023年第1期71-74,共4页Shaanxi Medical Journal

基　　金：西安市卫生计划科研项目(2019030770)。

摘　　要：目的:探究老年髋关节置换术患者全麻术后认知功能障碍(POCD)发生与脑动-静脉氧含量差值(BAOD)的相关性。方法:收集83例接受髋关节置换手术的老年患者为研究对象。患者术中均选择静脉全麻进行麻醉处理。测定计算患者麻醉诱导前、手术开始20 min和出麻醉苏醒室时的BAOD;依据术后是否发生POCD将其分为非POCD组和POCD组。对比分析不同时期BAOD与POCD的相关性。结果:83例患者全麻术后7 d内POCD患病率27.71%。POCD组患者平均年龄、受教育水平、丙泊酚用量、瑞芬太尼用量、术后24 h疼痛评分、术后镇痛补救比例和手术开始20 min时的BAOD均明显大于非POCD组(均P<0.05)。危险因素分析和受试者工作特征(ROC)曲线分析显示,手术开始20 min时的BAOD是全麻老年髋关节置换术患者POCD发生的危险因素之一,且其对POCD发生具有一定预测价值(AUC=0.701,95%CI为0.571~0.831),灵敏度和特异度分别为69.6%和75.0%。结论:全麻老年髋关节置换术患者术中BAOD水平是POCD发生的危险因素之一,对POCD发生具有一定预测价值。Objective:To investigate the correlation between postoperative cognitive dysfunction(POCD)and brain arterial-venous oxygen content difference(BAOD)after general anesthesia in elderly patients with hip replacement.Methods:A total of 83 elderly patients undergoing hip replacement surgery were collected as research objects.All patients were treated with intravenous general anesthesia.The BAOD of the patients before induction of anesthesia,20 minutes after the operation,and out of the anesthesia recovery room were measured and calculated.According to whether POCD occurred after operation,they were divided into non-POCD group and POCD group.The correlation between BAOD and POCD in different periods was analyzed.Results:The prevalence of POCD in 83 patients within 7 days after general anesthesia was 27.71%.The average age,education level,the dosage of propofol,the dosage of remifentanil,the 24-hour postoperative pain score,the postoperative analgesic rescue ratio,and the BAOD at 20 minutes after the operation in the POCD group were significantly higher than those in the non-POCD group(all P<0.05).Risk factor analysis and receiver operating characteristic(ROC)curve analysis showed that BAOD at 20 minutes after surgery was one of the risk factors for POCD in elderly hip replacement patients with general anesthesia,and it had a certain predictive value for POCD(AUC=0.701,95%CI:0.571 to 0.831),the sensitivity and specificity were 69.6%and 75.0%,respectively.Conclusion:Intraoperative BAOD level in elderly hip replacement patients with general anesthesia is one of the risk factors for the occurrence of POCD,and has a certain predictive value for the occurrence of POCD.

关 键 词：髋关节置换术 老年 全麻 认知功能障碍 氧供需 脑部 

分 类 号：R684[医药卫生—骨科学]