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

Abstract
Figure/Table
References (25)
Related Citation (15)

Download: PDF (767 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

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

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	WU Zhenpang WANG Lixia ZUO Wenjie NIE Guangchen ZHEN Xingang JU Ying XIAO Jingkuan CHEN Ning

Cite this article:

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[J]. 中国医药导报, 2023, 20(20): 134-137,145.

URL:

https://www.yiyaodaobao.com.cn/EN/10.20047/j.issn1673-7210.2023.20.29 OR https://www.yiyaodaobao.com.cn/EN/Y2023/V20/I20/134

[1] 黄武全，陆媛，于德华.上海市某近郊城区老年人轻度认知障碍患病率及其影响因素分析[J].中国医药导报，2019， 14（21）：59-63.
[2] Sanz-Reig J，Salvador Marín J，Ferrández Martínez J，et al. Prognostic factors and predictive model for in-hospital mortality following hip fractures in the elderly [J]. Chin J Traumatol，2018，21（3）：163-169.
[3] Grossman DC，Curry SJ，Owens DK，et al. Vitamin D，Calcium，or combined supplementation for the primary prevention of fractures in community-dwelling adults：us preventive services task force recommendation statement [J]. JAMA，2018， 319（15）：1592-1599.
[4] Robinson TN，Raeburn CD，Tran ZV，et al. Postoperative delirium in the elderly [J]. Ann Surg，2009，249：173-178.
[5] 周翠华，王菲，纪木火，等.老年患者术前衰弱与术后并发症的相关性[J].临床麻醉学杂志，2022，6（38）：613-616.
[6] 翟菲菲，黄宇光.围术期神经认知障碍：从术后到术前，从临床指标到生物学指标[J].临床麻醉学杂志，2019，35（4）：317-318.
[7] Singh PM，Borle A，Mc Gavin J，et al. Comparison of the recovery profile between desflu-rane and sevoflurane in patients undergoing bariatric surgery-A meta-analysis of randomized controlled trials [J]. Obes Surg，2017，27（11）：3031- 3039.
[8] Richter J，Sklienka P，Setra AE，et al. Is jugular bulb oximetry monitoring associated with outcome in out of hospital cardiac arrest patients [J]. J Clin Monit Comput，2020，35（4）：741- 748.
[9] Chen KL，Xu Y，Chu AQ，et al. Validation of the Chinese Version of Montreal Cognitive Assessment Basic for Screening Mild Cognitive Impairment [J]. J Am Geriatr Soc，2016， 64（12）：e285-e290.
[10] 王丹丹.中文版 MoCA-B量表在嘉兴市社区50岁以上人群中轻度认知功能障碍的诊断价值[D].蚌埠：蚌埠医学院，2018.
[11] 孙立，张宏，宋运琴.65岁以上老年人地氟醚肺泡气最低有效浓度测定[J].临床麻醉学杂志，2003，19（2）：72-73.
[12] 李娟，邹义壮，冯锋，等.澹妄评定方法修订及其信度、效度测试[J].临床精神医学杂志，2003，13（3）：147-149.
[13] 田帝，章豪，周典.基于大数据的老年人居家养老云服务平台构建策略[J].中国老年学杂志，2019，39（7）：1784- 1789.
[14] Campisi J，Kapahi P，Lithgow GJ，et al. From discoveries in ageing research to therapeutics for healthy ageing [J]. Nature，2019，571（7764）：183-192.
[15] Schenning KJ，Deiner SG. Postoperative delirium in the geriatric patient [J]. Anesthesiol Clin，2015，33（3）：505-516.
[16] Sharon K，Inouye MD. Delirium in older persons [J]. NEJM，2006，354（15）：72-77.
[17] 谭哲，李开南，兰海.骨科手术机器人导航辅助与传统髓内钉内固定治疗股骨转子间骨折的比较[J].中国组织工程研究，2019，23（24）：3792-3797.
[18] Zoremba M，Kratz T，Dette F，et al. Supplemental interscalene blockade to general anesthesia for shoulder arthro- scopy：effects on fast track capability，analgesic quality，and lung function [J]. Biomed Res Int，2015，2015：325012．
[19] 刘立涛，王志宁，刘晓鹏.不同麻醉方法对轻度认知功能障碍老年患者术后认知功能的影响[J].中国现代医生，2021，59（6）：116-120.
[20] Kowark A，Rossaint R，Pühringer F，et al. Emergence times and airway reactions during general anaesthesia with remi- fentanil and a laryngeal mask airway ：A multicentre randomised controlled trial [J]. Eur J Anaesthesiol，2018，35（8）：588-597.
[21] 杭燕南.地氟烷的药理和临床应用进展[J].上海医学，2010，33（4）：298-303.
[22] 李丽伟，李冰清，方申，等.地氟醚与七氟醚对机器人辅助膀胱癌治疗术老年患者脑氧代谢的影响[J].中国实用期刊，2019，32（13）：237-240.
[23] 刘萤瑞，段立波.地氟醚药理特性及其临床应用的研究进展[J].吉林大学学报（医学版），2018，44（2）：448-454.
[24] 吴萧林，周振锋，王宏法，等.脑血流量/脑氧代谢率预测非心脏手术老年患者术后认知功能障碍的可行性[J].浙江医学，2021，43（7）：716-720.
[25] Piotrowicz K，Klich-Raczka A，Pac A，et al. The diurnal profile of melatonin during delirium in elderly patients- preliminary results [J]. Exp Gerontol，2015，72：45-49.