不同镇静深度对高龄髋部骨折病人术后谵妄的影响

doi:10.3969/j.issn.1003-9198.2023.09.008

摘要/Abstract

摘要： 目的评价脑电双频指数(bispectral index,BIS)监测下的不同镇静深度对行髋部骨折手术的≥80岁高龄病人术后谵妄(POD)的影响。方法选取2019年1月至2022年1月期间因髋部骨折行择期髋关节置换术的高龄病人80例,采用随机数表法分为深镇静组(D组)和浅镇静组(L组),每组40例。D组术中维持BIS值在60～<70,L组术中维持BIS值在70～80,2组病人术中均予腰麻复合丙泊酚靶控输注(target controlled infusion,TCI),术后均行静脉自控镇痛。记录2组病人入室时(T1)、镇静开始时(T2)、手术开始时(T3)、手术开始30 min(T4)、手术开始60 min(T5)、手术结束时(T6)各时间点的BIS值、心率(HR)、平均动脉压(MAP)、SpO₂和呼气末二氧化碳(P_ETCO₂)水平,观察并比较2组病人镇静过程中不良反应、丙泊酚用量、术后苏醒时间和住院时间。采用ELISA法测定2组病人麻醉前(TⅠ)、术后24 h(TⅡ)、术后48 h(TⅢ)、术后72 h(TⅣ)血清S100-β水平。分别采用意识模糊评估量表(CAM)和谵妄严重程度评估量表(CAM-S)评估2组病人术后3 d内POD发生情况及严重程度。结果与T1时相比,D组T2～T6时MAP呈下降趋势(P＜0.05);与D组相比,L组T3～T6时BIS值均升高(P＜0.05)。与D组相比,L组TⅡ～TⅣ时血清S100-β浓度降低(P＜0.05),丙泊酚用量、术后苏醒时间和住院时间减少(P＜0.05);2组POD发生率差异无统计学意义(P＞0.05),但D组POD病人CAM-S评分高于L组(P＜0.05)。结论术中浅镇静时,BIS值维持在70～80可以减轻腰麻复合丙泊酚 TCI下行髋关节手术的高龄病人POD的严重程度,缩短麻醉苏醒时间和住院时间。

关键词: 镇静深度, 高龄, 髋部骨折, 术后谵妄

Abstract: Objective To evaluate the effect of different sedation depth monitored by bispectral index (BIS) on postoperative delirium(POD) in the elderly patients aged 80 years and over undergoing hip fracture surgery. Methods A total of 80 elderly patients with hip fracture who underwent the elective joint replacement from January 2019 to January 2022 were enrolled and randomly divided into the deep sedation group (group D) and the light sedation group (group L),with 40 cases in each group. BIS value was maintained at 60-＜70 in group D and 70-80 in group L. Spinal anesthesia combined with propofol target-controlled infusion (TCI) was performed during operation in both groups, and patient-controlled intravenous analgesia was performed after operation. BIS value, heart rate (HR), mean arterial pressure (MAP), finger pulse oxygen saturation (SpO₂) and end-tidal carbon dioxide (P_ETCO2) were recorded at admission (T1), the beginning of sedation (T2), the beginning of surgery (T3), 30 minutes after surgery (T4), 60 minutes after surgery (T5) and the end of surgery (T6). Adverse reactions during sedation, propofol dosage, postoperative recovery time and the hospital stay of the two groups were observed and compared. The serum level of S100-β was detected by ELISA before anesthesia (TⅠ), 24 hours after surgery (TⅡ), 48 hours after surgery (TⅢ), and 72 hours after surgery (TⅣ) in two groups. Confusion Assessment Scale (CAM) and Delirium Severity Assessment Scale (CAM-S) were used to assess the incidence and severity of POD during 3 days after the surgery. Results Compared with T1, MAP showed a decreasing trend in group D from T2 to T6 (P<0.05). BIS value from T3 to T6 was significantly increased in group L than that in group D (P<0.05). The serum level of S100-β from TⅡ to TⅣ, propofol dosage, postoperative recovery time and the hospital stay in group L were significantly lower than those in group D (P<0.05). There was no significant difference in the incidence rate of POD between the two groups (P>0.05), but the CAM-S score of the patients with POD in group D was significantly higher than that in group L. Conclusions Light sedation, maintaining BIS values at 70 to 80 during the operation can reduce the severity of POD and shorten anesthesia recovery time and hospital stay in the elderly patients undergoing hip replacement.

Key words: depth of sedation, aged, hip fracture, postoperative delirium

中图分类号:

R 614.2

马雪萍, 徐桂萍, 付鹃, 李育耕. 不同镇静深度对高龄髋部骨折病人术后谵妄的影响[J]. 实用老年医学, 2023, 37(9): 893-897.

MA Xue-ping, XU Gui-ping, FU Juan, LI Yu-geng. Effects of different depth of sedation on postoperative delirium in elderly patients undergoing hip replacement[J]. Practical Geriatrics, 2023, 37(9): 893-897.

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