目标导向液体治疗对老年患者术后早期认知功能的影响

Effect of goal-directed fluid therapy on early post operative cognitive dysfunction in elderly patients

关键词:  目标导向液体治疗  老年  术后认知功能

Key words:  goal-directed fluid therapy  elderly  postoperative cognitive function

摘要:

目的　探讨目标导向液体治疗对老年患者术后早期认知功能的影响。方法　选择全身麻醉下行单侧股骨头置换术患者60例，年龄65～80岁，随机分为常规液体治疗组（C组）和目标导向液体治疗组（G组），每组30例。C组术中采用经典输液方案进行术中液体管理，G组在LiDCO-rapid系统监测下，以每搏变异度（SVV）指导术中液体管理。分别于气管插管术后即刻（T1）、安装人工假体后即刻（T2）、缝皮后即刻（T3）及离室前（T4）记录两组患者脑血流量/脑氧代谢率比值(CBF/CMRO2)异常例数，分别于术后1 d和3 d进行简易智力量表（MMSE）和疼痛数字评分（VAS），并记录两组患者术中液体输入量。结果　术中液体输入量G组明显低于C组（P＜0.05）； T2及T2时刻CBF/CMRO2异常例数C组明显高于G组(P＜0.05）；术后1 d和3 d的术后早期认知功能障碍发生率C组明显高于G组（P＜0.05）；两组术后1 d和3 d的VAS评分无差异（P＞0.05）。结论　全身麻醉下老年患者术中实施目标导向液体治疗能够改善患者术中的脑氧代谢，并降低患者术后早期认知功能障碍的发生率。

Abstract:

Objective To investigate the effect of goal-directed fluid therapy on early post operative cognitive dysfunction in elderly patients. Methods Sixty elderly patients aged 65-80 years undergoing unilateral femoral head replacement surgery with general anesthesia were randomly divided into two groups base on treatment, conventional fluid therapy (group C) and goal-directed fluid therapy (group G) with 30 cases each. The patients in Group C received conventional fluid therapy and the patients in group G received goal-directed fluid therapy based on SVV with LiDCO-rapid system respectively during operation. The number of cases with abnormal CBF/CMRO2 was recorded immediately after tracheal intubation（T1）, after the installation of the femoral head（T2）, after skin suture（T3） and before leaving the operation room （T4） respectively. The mini-mental state examination (MMSE) and visual analogue scale (VAS) scores were evaluated at 1d and 3d after surgery of two groups, the fluid requirements were recorded too during surgery of two groups. Results Patients in group G were given a significant lower volume of intravenous fluids than it in group C during the intraoperaive period（P＜0.05）. The number of cases with abnormal CBF/CMRO2 in group C was higher than it in group G (P＜0.05）. On the 1st and 3rd postoperative day, the incidence of early post operative cognitive dysfunction in group C was significantly higher than that it in group G（P＜0.05）. The VAS scores did not exhibit significant difference between the two groups (P＞0.05). Conclusion The goal-directed fluid therapy can improve cerebral oxygen metabolism to the elderly patient with general anesthesia during operation and effectively decrease the incidence of early post operative cognitive dysfunction in elderly patients.