Effects Of Anesthesia Depth Adjustment Under Guidance Of BIS And RSO2 On Postoperative Delirium In The Elderly Undergoing Hip Replacement

Objective Postoperative delirium(POD)is an acute brain organic syndrome caused by various reasons.It is usually a mental state with acute onset and fluctuating course.It is characterized by changes in consciousness,orientation,attention,thinking,psychomotor behavior and emotion.Elderly patients are particularly common,often occurred within 24-72 hours after surgery.Bispectral index(BIS)and regional oxygen saturation(rSO2)monitoring can reflect the changes of brain function during operation,guide intraoperative anesthesia and reduce postoperative neurological complications.In this study,three different methods of brain function monitoring were used,and the anesthetic drugs and management plan were adjusted according to the monitoring results.The effect of bispectral index combined with cerebral oxygen saturation guiding the adjustment of anesthesia depth on delirium after hip replacement in the elderly was observed.Methods 150 elderly patients with unilateral hip arthroplasty were selected,aged 65-85 years.They were Cleavage three groups:BIS monitoring group(group A),rSO2 monitoring group(group B),BIS combined with rSO2 monitoring group(Group C).BIS value was controlled at 50-60,rSO2 value was controlled at 60%-70%.If the absolute value of split rSO2 value is less than 60%or the index is lower than 20%,the patients were given specific treatment,and the adjustment measures were to increase the oxygen concentration,adjust the blood pressure and hemoglobin,etc.;group C:combined with BIS and cerebral oxygen saturation monitoring,the BIS was improvedThe target value was maintained in the range of 50-60,and rSO2 was maintained in the range of 60%-70%.Record the amount of transfusion,blood loss,operation time,anesthesia time,recovery time,extubation time,and the use of vasoactive drugs(ephedrine,norepinephrine,etc.).The values of rSO2,BIS,PaCO2,mean blood pressure(map)and heart rate were recorded at all time points after entering the room(T0),after induction(T1),immediately after laryngeal mask insertion(T2),3min after intubation(T3),skin incision(T4),30min during operation(T5),60min during operation(T6)and at the end of operation(T7),HR),postoperative delirium(cam-cr)score,visual analogue(VAS)pain score,postoperative morbidity,length of stay in PACU,length of hospital stay and postoperative complications(restlessness,infection,hypoxemia,fever,nausea and vomiting,etc.)on the first,second and third day after operation.Results1.A total of 150 patients were included in this study.Group A,B and C each had 50 cases.Surgical anesthesia was carried out smoothly in the three groups without intraoperative blood transfusion.There were no statistical differences in age,sex composition ratio,ASA classification,BMI,preoperative HB,intraoperative blood loss,anesthesia,extubation and operative time among the three groups(P>0.05).2.There were no significant differences in the hemodynamic indexes,the percentage of cases using ephedrine and norepinephrine during operation and the postoperative VAS pain score among the three groups at each time point(P>0.05);3.Compared with group A and group B,the use of propofol and remifentanil in group C was significantly reduced(P<0.05);compared with group A and group B,the cam-cr index in group C was significantly decreased on the second and third day after operation compared with the first day(P<0.05).The incidence of postoperative delirium was 18%in group A,16%in group B and 6%in group C.compared with group A and B,the incidence of postoperative delirium in group C decreased significantly(P<0.05);4.Group A compared with group B,the happen of acute agitation in group C decreased significantly(P<0.05);hypoxemia and other symptoms occurred in the three groups(P>0.05);5.Logistic regression analysis showed that age,dosage of propofol and remifentanil during operation and agitation during recovery period were risk factors for postoperative pod(P<0.05)Conclusion BIS+rSO2 joint oriented anesthesia management can cut down the incidence of POD in suffers,which is conducive to the early recure of suffers.