国际麻醉学与复苏杂志   2018, Issue (8): 2-2
    
脑电双频指数监测下麻醉对老年合并中重度高血压膝关节置换手术患者术后谵妄的影响
徐彬彬, 李元海, 徐光红, 鲁显福, 王义桥1()
1.安徽医科大学第一附属医院麻醉科
Effect of bispectral index monitoring on postoperative delirium in elderly patients with moderate or severe hypertension undergoing total knee arthroplasty surgery
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摘要：

目的　观察BIS指导静脉全身麻醉对老年合并中重度高血压膝关节置换手术患者术后谵妄（postoperative delirium， POD）的影响。　方法　选择老年合并中重度高血压拟行择期单侧全膝关节置换手术患者80例，年龄63~80岁，ASA分级Ⅱ、Ⅲ级，纽约心脏病协会（NYHA）心功能分级Ⅰ、Ⅱ级，术前简易智力量表（Mini-Mental State Examination， MMSE）评分≥23分，采用随机数表法分为两组（每组40例）：经验麻醉组（E组）和BIS监测组（B组）。B组根据术中BIS值调整麻醉深度，E组根据临床体征和麻醉医师经验判断麻醉深度。记录两组患者诱导前（T0）、诱导后3 min（T1）、上止血带前（T2）、上止血带后30 min（T3）、松止血带前（T4）、松止血带后（T5）的血流动力学指标，并记录两组呼吸恢复时间、睁眼时间、拔管时间、PACU驻留时间、麻醉药物用量、血管活性药物用量以及麻醉相关并发症（躁动、苏醒延迟、术中知晓、术后恶心呕吐）发生情况，术后采用谵妄评估量表（the Confusion Assessment Method， CAM）评估术后3 d内POD发生情况。　结果　E组T1、T2时SBP分别为（112±9）、（103±7） mmHg（1 mmHg=0.133 kPa），TI时DBP为（66±7） mmHg，B组T1、T2时SBP分别为（119±11）、（108±9） mmHg，TI时DBP为（72±10） mmHg，与E组比较，B组T1、T2时SBP和T1时DBP均高于E组，差异有统计学意义（P<0．05）；B组丙泊酚用量［（322±49） mg］小于E组［（366±52） mg］，差异有统计学意义（P<0．05）；B组呼吸恢复时间［（4.3±1.5） min］、睁眼时间［（5.7±1.4） min］、拔管时间［（10.5±2.5） min］、PACU驻留时间［（32±5） min］短于E组［（5.6±2.1）、（7.4±2.1）、（12.1±2.5）、（35±6） min］，差异有统计学意义（P<0．05）；与E组比较，B组术后3 d POD总发生率（20.0%）明显低于E组（45.0%），差异有统计学意义（P<0．05）。　结论　BIS监测减少老年合并中重度高血压膝关节置换术患者术中全身麻醉药用量，提高老年全身麻醉患者术后苏醒质量，降低POD的发生率。
关键词： 脑电双频指数；　麻醉深度；　老年人；　高血压；　膝关节置换术；　术后谵妄
Abstract:

Ｏｂｊｅｃｔｉｖｅ　To investigate the effect of BIS-guided intravenous anesthesia on postoperative delirium (POD) in elderly patients with moderate or severe hypertension undergoing total knee arthroplasty surgery.　Methods　Eighty patients with moderate or severe hypertension, aged 63-80 years old, ASA Ⅱ or Ⅲ, NYHA Ⅰor Ⅱ, with preoperative Mini-Mental State Examination (MMSE) score≥23 scheduled for total knee arthroplasty surgery were enrolled in this study. The patients were randomly assigned to two groups with 40 patients per group: experience anesthesia group (group E) and BIS monitoring group (group B). The group B adjusted the depth of anesthesia according to intraoperative BIS value while experience anesthesia group anesthesia was adjusted according to traditional clinical signs and hemodynamic parameters. The hemodynamic parameters were recorded at time before anesthesia induction (T0), 3 min after induction (T1), at time before using tourniquet (T2), 30 min after tourniquet use (T3), before tourniquet release(T4) and after tourniquet release (T5). Observing the respiratory recovery time, eye opening time, extubation time, PACU residence time, the dosage of propofol, the dosage of vasoactive agent and the anesthesia related complication. POD was assessed within 3 d after operation using the confusion assessment method (CAM)．　Results　The SBP at the time of T1, T2 in group E were (112±9) mmHg (1 mmHg=0.133 kPa) and (103±7) mmHg while those values in group B were (119±11) mmHg and (108±9) mmHg respectively. The DBP at the time of T1 in group E was (66±7) mmHg while value in group B was (72±10) mmHg. Compared with group E, the SBP at the time of T1, T2 and DBP at the time of T1 in group B were higher than those values in group E (all P<0．05). The dosage of propofol in group B ［(322±49) mg］ was lower than the dosage of group E［(366±52) mg］. The time of respiratory recovery ［(4.3±1.5） min］, time of eye opening ［(5.7±1.4） min］, extubation time ［(10.5±2.5) min］ and PACU residence time ［(32±5） min］ in group B were shorter than those values in group E［ (5.6±2.1), (7.4±2.1), (12.1±2.5), (35±6) min］. Moreover, the overall incidence of POD in group B (20.0%) was significantly lower than that of group E (45.0%)（P<0．05）.　Conclusions　BIS monitoring reduces the amount of anesthetics used in elderly patients with moderate or severe hypertension undergoing total knee arthroplasty surgery. It leads to less incidence of POD three days after operation.
Key words: Bispectral index;　Depth of anesthesia;　Aged;　Hypertension;　Total knee arthroplasty;　Postoperative delirium