BIS指导下丙泊酚联合瑞芬太尼靶控输注对老年髋关节置换患者术中丙泊酚用量和术后谵妄发生率的影响  

Effect of Bispectral Index-Guided Propofol Combined with Remifentanil Target-Controlled Infusion on Intraoperative Propofol Dosage and Postoperative Delirium Incidence in Elderly Patients Undergoing Hip Arthroplasty

作　　者：朱磊磊 邬薇薇[1,2] 高武 赵仙雅 王纯辉 ZHU Leilei;WU Weiwei;GAO Wu(The First Affiliated Hospital of Anhui Medical University,Anhui Hefei 230000,China)

机构地区：[1]安徽医科大学第一附属医院麻醉科,安徽合肥230000 [2]安徽省公共卫生临床中心,安徽合肥230000

出　　处：《河北医学》2024年第3期429-435,共7页Hebei Medicine

基　　金：2020年度安徽省自然科学基金项目,(编号:2008085QH396)。

摘　　要：目的:探讨脑电双频指数(BIS)指导下丙泊酚联合瑞芬太尼靶控输注(TCI)对老年髋关节置换患者术中丙泊酚用量和术后谵妄发生率的影响。方法:回顾性分析老年髋部骨折患者的病例资料,依据患者接受的麻醉方式不同分为两组,即接受BIS指导下丙泊酚联合瑞芬太尼TCI麻醉的髋关节置换患者纳入观察组,接受BIS指导下丙泊酚联合瑞芬太尼持续静脉泵入的同类患者纳入对照组,建立二元Logistics回归分析,构建倾向性评分匹配模型分析得出观察组获取56例病例资料,对照组获取49例病例资料,组间差异无统计学意义(P>0.05)。观察两组不同时间点[入室后(T_(0))、麻醉后(T_(1))、骨水泥后(T_(2))、术毕(T_(3))、出室后(T_(4))、术后3h(T_(5))及术后5h(T_(6))时刻]的平均动脉压(MAP)、心率(HR)、手术一般情况、丙泊酚用量、BIS值维持情况,对比两组不同时间点(术前及术后1h、6h、1d、3d、7d时刻)谵妄评分[谵妄量表分析系统(CAM-CR)],记录两组术后谵妄发生率,比较两组不同时间点(术前及术后1d)的血糖(Glu)及血浆肾上腺素(E)、皮质醇(Cor)水平变化。结果:观察组在T_(1)时刻MAP值相比T_(0)时刻有显著性降低(P<0.05),两组均在T_(2)时刻MAP值相比T_(0)时刻有显著性降低(P<0.05),其中对照组在T_(5)、T_(6)及T_(7)时刻HR值相比T_(4)时刻出现显著性降低(P<0.05);两组手术时间、麻醉时间及术中出血量对比均差异无统计学意义(P>0.05),观察组丙泊酚用量显著少于对照组(P<0.05),观察组BIS值目标范围维持时间比显著高于对照组(P<0.05),观察组苏醒时间、气管拔管时间及定向力恢复时间显著短于对照组(P<0.05);术后1h、6h、1d、3d、7d,两组CAM-CR评分可见先升高后降低,均显著高于术前(P<0.05),观察组术后1h、6h、1d、3d的CAM-CR评分均显著低于对照组(P<0.05),两组术后7d的上述评分较术前和组间同时间点对比均差异无统计学意义(P>0.05);观�Objective:To investigate the effect of bispectral index(BIS)-guided propofol combined with remifentanil target-controlled infusion(TCI)on intraoperative propofol dosage and postoperative delirium incidence in elderly patients undergoing hip arthroplasty.Methods:A retrospective analysis was conducted on the case data of elderly patients with hip fractures.According to the different anesthesia methods received by the patients,they were divided into two groups:the observation group included patients who underwent hip arthroplasty under BIS-guided propofol combined with remifentanil TCI,and the control group included patients who underwent similar surgery under BIS-guided propofol combined with remifentanil continuous intravenous pump infusion.A binary logistic regression analysis was established to construct a propensity score matching model.The results showed that 56 cases were obtained in the observation group and 49 cases were obtained in the control group.There was no significant difference between the two groups(P>0.05).The parameters(mean arterial pressure(MAP),heart rate(HR)),general surgical conditions,propofol dosage,BIS value maintenance were compared between the two groups at different time points(after admission(T_(0)),after anesthesia(T_(1)),after bone cementation(T_(2)),at the end of surgery(T_(3)),after discharge(T_(4)),3 hours after surgery(T_(5))and 5 hours after surgery(T_(6))).The delirium scores(Confusion Assessment Method for the Intensive Care Unit(CAM-ICU))were compared between the two groups at different time points(preoperative and 1 hour,6 hours,1 day,3 days,and 7 days after surgery).The incidence of postoperative delirium and the changes in blood glucose(Glu)and plasma adrenaline(E)and cortisol(Cor)levels at different time points(preoperative and 1 day after surgery)were recorded and compared between the two groups.Results:MAP value at T_(1) was significantly decreased in observation group compared with that at T0(P<0.05),MAP value at T_(2) was significantly reduced in both groups compared

关 键 词：髋关节置换术 脑电双频指数指导 靶控输注 丙泊酚 瑞芬太尼 老年髋部骨折患者 术后谵妄 

分 类 号：R614[医药卫生—麻醉学]