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

Abstract

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

CLC Number:

R 614.2

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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Effects of different depth of sedation on postoperative delirium in elderly patients undergoing hip replacement

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