不同浓度地氟醚复合静脉麻醉对伴有轻度认知障碍的老年髋部骨折患者术中脑氧代谢及对术后谵妄的影响

doi:10.20047/j.issn1673-7210.2023.20.29

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摘要目的观察不同浓度地氟醚复合静脉麻醉对伴有轻度认知障碍（MCI）的老年髋部骨折患者术中脑氧代谢及术后谵妄发生的影响。方法选取2022年1月至10月哈尔滨市第五医院骨科收治的90例伴有MCI的老年髋部骨折患者，采用随机数字表法将其分为1%地氟醚组（D1组）、3%地氟醚组（D2组）、5%地氟醚组（D3组），各30例。所有患者均在全麻下接受骨科手术机器人辅助股骨近端髓内钉内固定术。比较三组苏醒时间、拔管时间、麻醉恢复室（PACU）停留时间、丙泊酚的使用剂量及血管活性药物使用人数；比较三组诱导后即刻（T1）、缝皮时（T2）脑血流量/脑氧代谢率（CBF/CMRO2）和颈内静脉球部血氧饱和度（SjvO2）；比较三组术后3 d内术后谵妄的发生情况。结果三组苏醒时间、拔管时间、PACU停留时间、丙泊酚用量比较，差异有统计学意义（P＜0.05）；三组血管活性药物使用人数比较，差异无统计学意义（P＞0.05）。D3组苏醒时间、拔管时间、PACU停留时间短于D1组，长于D2组；丙泊酚用量低于D1、D2组，差异有统计学意义（P＜0.05）。D2组苏醒时间、拔管时间、PACU停留时间短于D1组；丙泊酚用量低于D1组，差异有统计学意义（P＜0.05）。T1时，三组CBF/CMRO2、SjvO2比较，差异无统计学意义（P＞0.05）；T2时，三组CBF/CMRO2、SjvO2比较，差异有统计学意义（P＜0.05）；D3组CBF/CMRO2、SjvO2高于D1、D2组，D2组CBF/CMRO2、SjvO2高于D1组，差异有统计学意义（P＜0.05）。三组术后谵妄人数比较，差异有统计学意义（P＜0.05）。结论3%地氟醚复合静脉麻醉可降低MCI老年髋部骨折患者术中的脑代谢，有利于术后早期恢复和减少术后谵妄的发生，值得在临床上推广。

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	武振庞　　王丽霞　　左文杰　　聂广辰　　甄鑫钢　　鞠影　　肖景宽　　陈宁

关键词 ：地氟醚, 轻度认知障碍, 老年, 髋部骨折, 术中脑氧代谢, 术后谵妄

Abstract：Objective To observe the effect of different concentrations of Desflurane combined with intravenous anesthesia on intraoperative cerebral oxygen metabolism and postoperative delirium in elderly hip fracture patients with mild cognitive impairment (MCI). Methods A total of 90 elderly hip fracture patients with MCI admitted to the Department of Orthopedics, the Fifth Hospital of Harbin City from January to October 2022 were selected. They were divided into 1% Desflurane group (group D1), 3% Desflurane group (group D2), and 5% Desflurane group (group D3) by random number table method, with 30 cases in each group. All patients underwent robot-assisted proximal femoral intramedullary nail fixation under general anesthesia. The awakening time, extubation time, postanesthesia care unit (PACU) residence time, Propofol dosage, and the number of vasoactive drug users among three groups were compared; the cerebral blood flow/cerebral metabolic rate of oxygen (CBF/CMRO2) and jugular venous oxygen saturation (SjvO2) among three groups were compared immediately after induction (T1) and at suture (T2); the incidence of postoperative delirium among three groups within three days after operation was compared. Results There were statistically significant differences in awakening time, extubation time, PACU residence time, and Propofol dosage among three groups (P＜0.05); the recovery time, extubation time, and PACU residence time in group D3 were shorter than those in group D1, and longer than those in group D2; and Propofol dosage was lower than those in group D1 and D2, and the differences were statistically significant (P＜0.05). The recovery time, extubation time, and PACU residence time in group D2 were shorter than those in group D1, and Propofol dosage was lower than that in group D1, and the differences were statistically significant (P＜0.05). At T1, there were no significant differences in CBF/CMRO2 and SjvO2 among three groups (P＞0.05); at T2, there were significant differences in CBF/CMRO2 and SjvO2 among three groups (P＜0.05); the CBF/CMRO2 and SjvO2 in group D3 were higher than those in group D1 and D2, and the CBF/CMRO2 and SjvO2 in group D2 were higher than those in group D1, and the differences were statistically significant (P＜0.05). There was statistical significance in the number of postoperative delirium among three groups (P＜0.05). Conclusion 3% Desflurane combined intravenous anesthesia can reduce the intraoperative brain metabolism in elderly hip fracture patients with MCI, which is conducive to early postoperative recovery and reduce the occurrence of postoperative delirium, and is worthy of clinical promotion.

Key words： Desflurane Mild cognitive impairment Elderly Hip fracture Intraoperative cerebral oxygen metabolism Postoperative delirium

基金资助:黑龙江省卫生健康委员会科研课题资助项目（20210404110143）。

通讯作者: 左文杰（1981.1-），女，硕士，副主任医师；研究方向：老年骨科患者围手术期脑保护。

作者简介: 武振庞（1981.12-），男，硕士，副主任医师；研究方向：老年骨科患者围手术期脑保护。

引用本文:

武振庞　　王丽霞　　左文杰　　聂广辰　　甄鑫钢　　鞠影　　肖景宽　　陈宁 . 不同浓度地氟醚复合静脉麻醉对伴有轻度认知障碍的老年髋部骨折患者术中脑氧代谢及对术后谵妄的影响[J]. 中国医药导报, 2023, 20(20): 134-137,145.
WU Zhenpang WANG Lixia ZUO Wenjie NIE Guangchen ZHEN Xingang JU Ying XIAO Jingkuan CHEN Ning. Effect of different concentrations of Desflurane combined with intravenous anesthesia on intraoperative cerebral oxygen metabolism and postoperative delirium in elderly hip fracture patients with mild cognitive impairment. 中国医药导报, 2023, 20(20): 134-137,145.

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