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目的:探讨老年髋关节置换术中应用静吸复合麻醉与全凭静脉麻醉的效果。方法:队列研究。抽取2022年1月至2023年7月陕西省核工业二一五医院收治的120例老年髋关节置换术患者，按照双色球法分为对照组(全凭静脉麻醉)与观察组(静吸复合麻醉)，每组60例。比较两组血流动力学参数、认知功能、早期术后认知功能障碍(POCD)发生率、苏醒评分及苏醒期谵妄发生率。结果:麻醉前、麻醉诱导5 min，两组血流动力学参数比较差异未见统计学意义( P>0.05)；切皮后30 min，观察组平均动脉压与心率均低于对照组( P均<0.05)。麻醉前，两组简易精神状态量表(MMSE)评分与蒙特利尔认知评估表(MoCA)评分比较差异未见统计学意义( P>0.05)；术后2、6、24 h，观察组MMSE评分、MoCA评分均高于对照组( P均<0.05)。术后12、36 h，观察组早期POCD发生率低于对照组( P<0.05)；拔管后1、5、10 min，观察组Steward苏醒评分高于对照组( P<0.05)；术后3 d、5 d、1周，观察组苏醒期谵妄发生率低于对照组( P<0.05)。 结论:与全凭静脉麻醉比较，在老年髋关节置换术中实施静吸复合麻醉，不仅对血流动力学影响更小，而且对认知功能影响更轻，POCD发生率更低，同时还能维持术后良好的苏醒状态，减少苏醒期谵妄发生。

Objective:To investigate the effects of combined intravenous-inhalation anesthesia and total intravenous anesthesia in elderly hip replacement arthroplasty.Methods:A cohort study was conducted on 120 elderly patients who underwent hip replacement arthroplasty in NO. 215 Hospital of Shaanxi Nuclear Industry from January 2022 to July 2023. The selected patients were divided into a control group (with total intravenous anesthesia) and an observation group (with combined intravenous-inhalation anesthesia) using the two-color ball method, with 60 cases in each group. The hemodynamic indexes, cognitive function, incidence of early postoperative cognitive dysfunction (POCD), awakening score and incidence of delirium during the awakening period of the two groups were compared. Results:There was no significant difference in hemodynamic indexes between the two groups before anesthesia and 5 minutes after anesthesia induction ( P>0.05), but the mean arterial pressure and heart rate of the observation group were lower than those of the control group 30 minutes after skin incision (all P<0.05). Before anesthesia, there was no significant difference in the mini-mental state examination (MMSE) score and the Montreal Cognitive Assessment (MoCA) score between the two groups ( P>0.05). The MMSE score and MoCA score of the observation group were higher than those of the control group at 2, 6 and 24 hours after surgery (all P<0.05). Compared with the control group, the 12- and 36-hour postoperative incidence of early POCD in the observation group were lower, while the 1- 5- and 10-minute postoperative Steward awakening score in the observation group were higher, and 1-day, 5-day and 1-week postoperative incidence of delirium during the awakening period in the observation group were lower ( P<0.05). Conclusions:Compared with total intravenous anesthesia, combined intravenous-inhalation anesthesia in elderly hip replacement arthroplasty has a smaller impact on hemodynamics and cognitive function and a lower incidence of POCD, moreover, it can maintain a good postoperative state and reduce the occurrence of delirium during the recovery period.