| Background:Postoperative delirium(postoperative delirium; POD) is the early onset of anesthesia after an acute encephalopathy syndrome. The clinical features of consciousness, thinking, memory, cognition, sleep disorders, and other aspects of the orientation. In recent decades, along with the growing aging population and rapid rehabilitation of the concept of minimally invasive surgery and popularity, more and more elderly patients can undergo surgery,the incidence of postoperative complications of each system also will increased. Studies have shown that the incidence of postoperative delirium in elderly patients is 10% to 50%. Postoperative delirium increases the length of stay of patients so that the suffering of patients and their families increases,increased cost of hospitalization, postoperative mortality. Now that the incidence of postoperative delirium and risk factors of age, depth of anesthesia, preoperative underlying diseases, surgical procedures, low oxygen and low blood pressure, sleep disorders after surgery, anesthesia anesthesia-related drugs, studies have shown that the depth of anesthesia is POD is an important risk factors, and Narcotrend(depth of anesthesia awareness monitor) can effectively monitor the depth of anesthesia reaction.At home and abroad have not been studies on Narcotrend monitoring the depth of anesthesia for arthroplasty in elderly patients delirium impact of research reports. This study explores the depth of anesthesia and postoperative delirium correlation.Objective:Discussion Intraoperative monitoring in Narcotrend different depth of anesthesia for arthroplasty in elderly patients undergoing influence of postoperative delirium.Methods:The final experiment included 180 cases from March 2015 to February2016 at the First Hospital of Jilin University Bethune Bone and Joint Surgery,accepting unilateral unilateral hip replacement surgery or knee replacement surgery. Patients between the ages of 65-89, according to a random number table were randomly divided into A, B, C three groups. According to intraoperative EEG readings Narcotrend monitor display, respectively, their depth of anesthesia control in D0-D1(A group), D2-E0(group B), E1(group C) levels, all patients underwent routine monitor. Hemodynamic parameters were recorded in the operating room; recorded before induction of anesthesia(T0), before intubation(T1), at the start of surgery(T2), after the operation began 1 h(T3), 2 h after the beginning of surgery(T4), end of the operation(T5) heart rate(HR), blood pressure(BP). Record intraoperative propofol and remifentanil dosage of vasoactive drugs and drug use, and intraoperative fluid volume, blood volume, blood loss, urine output and so on. Records of patients extubation time, postoperative follow-up of patients the incidence of intraoperative awareness. Using the most commonly used diagnostic criteria for delirium; consciousness disorder occurs in the case of POD test method(confusion assessment method, CAM) after 3 days of evaluation,postoperative hospitalization time record of each case.Results:Three groups of patients age, BMI index, gender, ASA classification of the case for comparison, these differences were found in the three groups was not statistically significant(P> 0.05). Three groups of patients anesthesia time, operative time, intraoperative transfusion, blood transfusion surgery,intraoperative urine output difference was not statistically significant(P>0.05), differences in the amount and activity of vascular drugs propofol these three groups of patients there was statistically significant(P <0.05), the difference of remifentanil dosage was not statistically significant(P> 0.05).In this study, because the relationship between sample size included knee replacement surgery(92 cases) and hip replacement surgery(88 cases) two surgical patients, collected two surgical patient anesthesia time, operative time, intraoperative blood loss, intraoperative urine output and postoperative delirium occurrence of the relevant information and found that the two procedures in surgery time, anesthesia time, there are differences in terms of the amount of bleeding significantly different(P <0.05), the two procedures postoperative delirium differences in the incidence was not statistically significant(P> 0.05). In this study, patients were collected at the target depth of anesthesia time, which accounts for the entire time during anesthesia percentage calculation, the three groups of patients in the percentage of time the total target depth of anesthesia anesthesia time was compared with that difference was not statistically significant(P> 0.05). For six different time points hemodynamic indices were compared and found that among patients with hemodynamic differences between groups was not statistically significant(P> 0.05), record the patient’s extubation was found between the groups pull tube time difference were statistically significant(P <0.05).Postoperative follow-up of patients with intraoperative awareness circumstances, A group occurred in two patients suspected know other patients and no cases of intraoperative awareness occurs. The case within three days of the occurrence of postoperative delirium patients were followed up and found that four cases of delirium A group of 58 patients postoperative delirium 13 cases of group B 63 postoperative patients, group C 59 patients after operation 24 cases of delirium occur, A group and B group difference was statistically significant, A group and C group differences were statistically significant, group B and group C, the difference was statistically significant. Patients compared with patients without POD POD occurred;postoperative hospital stay was significantly prolonged.。Conclusion:Maintain the depth of anesthesia in Narcotrend depth of anesthesia interval D2-E0, only help to reduce the incidence of POD, but also help to reduce the incidence of intraoperative awareness. |
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