2021 年第 2 期 第 16 卷

丙泊酚闭环靶控输注对老年膝关节置换术患者术后谵妄的影响

The effect of closed-loop target controlled infusion of propofol on postoperative delirium in elderly patients after knee arthroplasty

作者：姚杰1 刘斐2 冯腾尘1 陈艳林1 徐晓晴2 滕金亮1 李福龙1

英文作者：Yao Jie1 Liu Fei2 Feng Tengchen1 Chen Yanlin1 Xu Xiaoqing2 Teng Jinliang1 Li Fulong1 

单位：1河北北方学院附属第一医院麻醉科，河北省张家口市075000；2河北北方学院附属第一医院重症医学科，河北省张家口市075000

英文单位：1Department of Anesthesiology the First Affiliated Hospital of Hebei North University Hebei Province Zhangjiakou 075000 China; 2Department of Intensive Care Unit the First Affiliated Hospital of Hebei North University Hebei Province Zhangjiakou 075000 China

关键词：膝关节置换术；谵妄；闭环靶控输注；丙泊酚

英文关键词：

• 摘要：

• 目的 探讨丙泊酚闭环靶控输注对老年膝关节置换术患者术后谵妄的影响。方法 选择2017年6月至2018年12月在河北北方学院附属第一医院全身麻醉下行择期单侧膝关节置换术的老年患者120例。按照随机数字表法分为观察组（采用闭环靶控输注法输注丙泊酚）和对照组（采用经验靶控输注法泵注丙泊酚），每组60例。2组采用相同的麻醉诱导方式，记录所有患者术中平均动脉压、心率、麻醉时间、手术时间、输液量、出血量、尿量，丙泊酚、瑞芬太尼、顺式阿曲库铵的总用量，以及躁动、恶心呕吐和术中知晓等不良反应情况；采用谵妄评定法评估患者术后谵妄状态。结果 2组患者均无术中知晓发生，术后恶心呕吐和躁动发生率差异均无统计学意义(均P>0.05)。观察组围术期丙泊酚、苯磺顺阿曲库铵总用量少于对照组［（781±70）mg比（963±63）mg、（15±7）mg比（20±7）mg］，差异均有统计学意义（均P<0.05）。观察组术后谵妄发生率低于对照组［18.6%（11/59）比39.7%（23/58）］，差异有统计学意义(χ2=3.412，P=0.015)。结论 丙泊酚闭环靶控输注可减少老年患者全身麻醉药物的用量，并显著降低患者术后谵妄的发生率。

• Objective To investigate the effect of closed-loop target controlled infusion of propofol on postoperative delirium in elderly patients after knee arthroplasty. Methods From June 2017 to December 2018, 120 elderly patients underwent selective unilateral knee arthroplasty under general anesthesia in the First Affiliated Hospital of Hebei North University were selected. According to the method of random number table, they were divided into observation group(propofol was infused by closed-loop target controlled infusion) and control group(propofol was infused by experience target controlled infusion)，with 60 cases in each group. Anesthesia induction was same in the two groups. Indicators intraoperation were recorded including mean arterial pressue, heart rate, anesthesia time, surgery time, infusion volume, blood loss and urine volume. The total use of propofol, remifentanil, cisatraeurium were calculated; the incidences of emergence agitation, nausea, vomiting and intraoperative awareness were recorded. Delirium assessment was used to evaluate the postoperative delirium of the patients. Results  There was no intraoperative awareness in both groups. There were no significant differences in the incidences of postoperative nausea, vomiting and agitation between the two groups(all P>0.05). The total dosages of propofol and cisatracurium in observation group were lower than those in control group［（781±70）mg vs （963±63）mg, （15±7）mg vs （20±7）mg］(both P<0.05). The incidence of postoperative delirium in observation group was lower than that in control group ［18.6%(11/59) vs 39.7%(23/58), χ2=3.412, P=0.015］. Conclusions Closed-loop target controlled infusion of propofol can reduce dosages of anesthetics. It can reduce the incidence of postoperative delirium.