【摘要】 目的 探讨依托咪酯联合丙泊酚闭环靶控输注在老年患者脊柱手术麻醉的有效性及安全性。方法 选择本院2020年7月到2021年7月60例择期脊柱手术的老年患者（男25例，女35例）,ASAⅡ、Ⅲ级，随机分为两组，每组30例。观察组采用依托咪酯诱导联合丙泊酚闭环靶控输注维持麻醉，对照组采用丙泊酚诱导及闭环靶控输注维持麻醉。记录患者入手术室后5 min（T₀）、插管前即刻（T₁）、插管后3 min（T₂）、转俯卧位前1 min（T₃）、转俯卧位后3 min（T₄）、缝皮结束时（T₅）、转平卧位后3 min（T₆）的心率（HR）及平均动脉压（MAP）值，并发症发生情况及简易智能精神状态检查量表（MMSE）评分。结果 观察组在插管前即刻、插管后3 min、转俯卧位前1 min的MAP高于对照组（P<0.05）;观察组在插管后3 min的HR值高于对照组（P<0.05）;观察组：肌振挛3例，术后躁动3例，呕吐5例；对照组：术后躁动5例，呕吐2例，差异无统计学意义（P>0.05）;两组术后第1天MMSE评分与术前第1天比较均下降，差异有统计学意义（P<0.05）。结论 依托咪酯联合丙泊酚闭环靶控输注在老年患者脊柱手术的麻醉患者血流动力学平稳维持，安全有效，值得临床推广应用。更多还原

【Abstract】 Objective To investigate the effectiveness and safety of combined etomidate and propofol with closed-loop target-controlled infusion for anesthesia in spinal surgery of elderly patients. Methods A total of 60 elderly patients（25 males and 35 females） with ASA grade Ⅱ and Ⅲ undergoing elective spine surgery from July 2020 to July 2021 at The Second Nanning People’s Hospital were selected and randomly divided into two groups with 30 patients in each group. The observation group received etomidate induction with closed-loop target-controlled infusion of propofol to maintain anesthesia, while the control group received propofol induction with closed-loop target-controlled infusion to maintain anesthesia. The heart rate（HR） and mean arterial pressure（MAP）, as well as the occurrence of complications and Mini-Mental State Examination（MMSE） scores, were recorded at the following time points: 5 min after patients entered the operating room（T₀）, immediately before intubation（T₁）, 3 min after intubation（T₂）, 1 min before turning to prone position（T₃）, 3 min after turning to prone position（T₄）, the end of skin closure（T₅）, 3 min after turning to supine position（T₆）. Results The observation group showed higher MAP values than the control group immediately before intubation, 3 min after intubation, and 1 min before turning to the prone position（P<0.05）; The observation group had a higher HR value than the control group at 3 min after intubation（P<0.05）; Complications such as myoclonus, postoperative agitation, and vomiting were observed in both groups, but the differences were not statistically significant（P>0.05）; The MMSE scores of both groups on the first day after surgery were significantly decreased compared to the day before surgery, and the difference was statistically significant（P<0.05）. Conclusion Combined etomidate and propofol with closed-loop target-controlled infusion provides effective and safe anesthesia maintenance with stable hemodynamics in elderly patients undergoing spinal surgery. It is a valuable technique that can be promoted and applied in clinical practice.更多还原