右美托咪定复合不同麻醉深度在老年全髋关节置换术患者中的麻醉效果探讨及术后谵妄的危险因素分析

摘要 目的：探讨右美托咪定复合不同麻醉深度在老年全髋关节置换术（THA）患者中的麻醉效果，并分析其发生术后谵妄的危险因素。方法：选取我院2020年7月~2022年1月期间收治的130例老年THA患者。根据术中麻醉意识深度分为A、B、C组，其中A组41例，脑电双频指数（BIS）值为40~49；B组43例，BIS值为50~59；C组46例，BIS值为60~69。观察三组患者的麻醉效果，包括苏醒质量、术后谵妄发生情况、麻醉不良反应。根据术后是否发生谵妄将患者分为无谵妄组和谵妄组，采用单因素和多因素Logistic回归分析老年THA患者发生术后谵妄的危险因素。结果：A组、B组的恢复自主呼吸时间、呼叫开始至睁眼时间短于C组，且B组短于A组（P<0.05）。B组的麻醉不良反应发生率较A组和C组低（P<0.05）。麻醉不良反应发生率A组和C组对比无统计学差异（P>0.05）。B组的谵妄发生率较A组和C组低（P<0.05）。A组、C组的谵妄发生率组间对比无统计学差异（P>0.05）。单因素分析结果显示：术后谵妄的发生与年龄、体质量指数、美国麻醉医师协会分级（ASA）分级、冠心病、术中出血量、血钠浓度、术后低氧血症、术前合并低蛋白血症、术前焦虑、麻醉时间、术后贫血有关（P<0.05）。多因素Logistic回归分析结果显示：年龄偏高、术后贫血、体质量指数偏低、血钠浓度偏低、术中出血量偏多、术后低氧血症、麻醉时间偏长、术前合并低蛋白血症是老年THA患者术后谵妄发生的危险因素（P<0.05）。结论：BIS值为50~59的情况下复合右美托咪定治疗老年THA患者，可获得较好的麻醉效果，可降低术后谵妄、不良反应发生率。此外，年龄、术后贫血、体质量指数、血钠浓度、术中出血量、术后低氧血症、麻醉时间、术前合并低蛋白血症均是老年THA患者术后谵妄发生的影响因素。

Effect of Dexmedetomidine Combined with Different Anesthesia Depth on Elderly Patients Undergoing Total Hip Arthroplasty and Analysis of Risk Factors for Postoperative Delirium

ABSTRACT Objective: To investigate the anesthetic effect of dexmedetomidine combined with different anesthesia depth in elderly patients undergoing total hip replacement (THA), and to analyze the risk factors of postoperative delirium. Methods: 130 elderly patients with THA who were admitted to our hospital from July 2020 to January 2022 were selected. According to the anesthesia consciousness depth, the patients were divided into groups A, B and C, among group A had 41 cases, the EEG bispectral index (BIS) value was 40~49. The group B had 43 cases, the BIS value was 50~59. The group C had 46 cases, the BIS value was 60~69. The anesthetic effects in the three groups were observed, included the waking quality, occurrence of postoperative delirium and adverse reactions to anesthesia. Patients were divided into delirium group and non-delirium group according to the occurrence of postoperative delirium. Clinical data of patients were collected. Univariate and multivariate Logistic regression were used to analyze the risk factors of postoperative delirium in elderly patients with THA. Results: The recovery time of spontaneous breathing and the time from the start of call to eye opening in the group A and group B were shorter than those in the group C, andthe group B was shorter than the group A(P<0.05). The incidence of anaesthetic adverse reactions in the group B was lower than that in the group A and group C(P<0.05). There was no significant difference in the incidence of anaesthetic adverse reactions between group A and group C(P>0.05). The incidence of delirium in the group B was lower than that in the group A and group C(P<0.05). There was no significant difference in delirium incidence between group A and group C(P>0.05). The results of univariate analysis showed that: the occurrence of postoperative delirium was correlated with age, body mass index, American Society of Anesthesiologists (ASA) grade, coronary heart disease, intraoperative blood loss, blood sodium concentration, postoperative hypoxemia, preoperative combined with hypoproteinemia, preoperative anxiety, anesthesia time and postoperative anemia(P<0.05). Multivariate Logistic regression analysis showed that higher age, postoperative anemia, lower body mass index, lower blood sodium concentration, more intraoperative blood loss, postoperative hypoxemia, longer anesthesia time and preoperative combined with hypoproteinemia were risk factors for postoperative delirium in elderly patients with THA (P<0.05). Conclusion: When BIS value is 50~59, dexmedetomidine combined with dexmedetomidine in the treatment of elderly patients with THA can obtain better anesthetic effect and reduce the incidence of postoperative delirium and adverse reactions. In addition, age, postoperative anemia, body mass index, blood sodium concentration, intraoperative blood loss, postoperative hypoxemia, anesthesia time, preoperative combined with hypoproteinemia are all influencing factors for postoperative delirium in elderly patients with THA.