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

doi:10.3969/j.issn.1006-6233.2024.03.014

Abstract
Figure/Table
References
Related Citation (15)

Download: PDF (1233 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract 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 (T₀), after anesthesia (T₁), after bone cementation (T₂), at the end of surgery (T₃), after discharge (T₄), 3 hours after surgery (T₅) and 5 hours after surgery (T₆)). 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 T₁ was significantly decreased in observation group compared with that at T0 (P<0.05), MAP value at T₂ was significantly reduced in both groups compared with that at T0 (P<0.05), and HR value at T₅, T₆ and T₇ in control group was significantly decreased compared to T₄ (P<0.05). There were no significant differences in surgical time, anesthesia time and intraoperative blood loss between the two groups (P>0.05). The dosage of propofol in observation group was significantly less than that in control group (P<0.05), and the BIS target range maintenance time ratio was significantly longer than that in control group (P<0.05) while the recovery time, tracheal extubation time and orientation recovery time were significantly shorter than those in control group (P<0.05). At 1h, 6h, 1d, 3d and 7d after surgery, the CAM-CR score in the two groups was firstly increased and then decreased, and was significantly higher than that before surgery (P<0.05). The CAM-CR scores in observation group at 1h, 6h, 1d and 3d after surgery were significantly lower than those in control group (P<0.05). There were no significant differences in the score at 7d after surgery compared to before surgery and between the two groups at the same time point (P>0.05). The incidence rate of postoperative delirium in observation group was 5.36%, which was significantly lower than 18.37% in control group (P<0.05). The levels of Glu and plasma E and Cor in the two groups were significantly increased at 1 d after surgery (P<0.05), but the levels in observation group were significantly lower than those in control group (P<0.05). Conclusion: The application of BIS-guided TCI of propofol combined with remifentanil in elderly patients with hip replacement can stabilize the hemodynamics, improve the perioperative indicators, reduce the dosage of propofol, improve the maintenance of BIS value, promote the anesthesia recovery, reduce the risk of postoperative delirium, and relieve the body’ s stress response.

Key words： Hip replacement Bispectral index guidance Target controlled infusion Propofol Remifentanil Elderly patients with hip fractures Postoperative delirium

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2024.03.014 OR http://www.hbyxzzs.cn/EN/Y2024/V30/I3/429

[1] 叶小东,黄家谷,王小勇.人工髋关节置换术治疗老年陈旧性股骨粗隆间骨折疗效观察[J].中国骨与关节损伤杂志,2021,36(12):1287-1288.
[2] 武志平,安晓刚,孔雅俊.不同浓度氟比洛芬酯超前镇痛对行髋关节置换术老年患者认知功能及IL-6浓度的影响[J].河北医学,2021,27(11):1777-1782.
[3] 李旻,王娜,蒋雨宸,等.老年股骨颈骨折人工股骨头置换术后迈之灵片和鲑鱼降钙素联合应用的临床疗效[J].中国综合临床,2021,37(2):154-160.
[4] 刘卢,梁苏荣,潘在礼,等.右美托咪定复合小剂量瑞芬太尼在老年患者髋关节置换术中的静脉优化效应[J].中华全科医学,2022,20(4):606-610.
[5] 莫家玲,覃之人,黄伟波,等.脑电双频指数监测下丙泊酚闭环靶控输注对妇科腹腔镜手术患者术中知晓和术后恢复的影响[J].广西医学,2022,44(18):2095-2098,2112.
[6] 闫威,李翊,祝雁冰.骨关节病诊疗指南[M].北京:科学技术文献出版社,2013.59-63.
[7] 霍建臻,高媛媛,党炳文.脑电双频指数监测下不同麻醉深度对腹腔镜下老年消化道肿瘤手术患者的影响[J].陕西医学杂志,2022,51(6):721-724.
[8] 彭罗方,陈旦,汪同旋,等.丙泊酚闭环靶控输注下不同麻醉深度控制水平复合神经阻滞在老年人工髋关节置换术中的应用[J].中国医师杂志,2021,23(11):1677-1681.
[9] 江华勇,劳伟龙,周国忠,等.不同麻醉镇静深度BIS闭环靶控输注对腹腔镜胃癌根治术老年患者围术期Th1/Th2平衡的影响[J].肿瘤防治研究,2022,49(5):444-447.
[10] 彭毅,王福刚,丁庆民.腰椎旁神经阻滞联合全凭静脉麻醉对髋关节置换术患者血流动力学、应激反应、术后苏醒的影响[J].河北医科大学学报,2021,42(4):461-465.
[11] 张宏,李淑萍.老年患者髋关节置换术后谵妄的发生现状及其相关影响因素分析[J].长春中医药大学学报,2022,38(10):1155-1159.
[12] 王雨辰,俞伟忠.帕瑞昔布钠超前镇痛对老年髋部骨折术后疼痛和应激反应影响[J].中国骨伤,2021,34(7):612-616.