急性高容血液稀释联合控制性降压对老年脊柱手术患者术后认知功能的影响  

Effect of acute hypervolemic hemodilution combined with controlled hypotension on postoperative cognitive function after the spinal surgery in elderly patients

作　　者：刘艳红[1] 张思彦[1] 

机构地区：[1]山东省潍坊市益都中心医院麻醉科,262500

出　　处：《中国医药》2014年第7期1000-1002,共3页China Medicine

摘　　要：目的观察急性高容血液稀释（AHH）联合控制性降压（CH）用于老年脊柱手术患者对其术后认知功能的影响，以评估该血液保护策略应用于老年人的安全性。方法选择2010年9月至2012年3月潍坊市益都中心医院择期脊柱手术的老年患者60例，采用随机数字表法分为联合组和对照组，每组30例。对照组给予常规麻醉，联合组在常规麻醉基础上，给予6%羟乙基淀粉130/0.4氯化钠注射液联合盐酸尼卡地平注射液静脉滴注。分别于术前1 d和术后4 d评定患者的认知功能，比较2组患者术后认知功能障碍（POCD）的发生率。结果2组术后4 d视觉再认、符号测验评分均高于本组术前1 d，差异有统计学意义[联合组视觉再认：（15.9±3.5）分比（13.3±2.4）分，对照组视觉再认：（16.1±3.4）分比（12.0±2.7）分；联合组符号测验：（14.7±1.4）分比（12.8±1.7）分，对照组符号测验：（15.8±2.2）分比（12.5±2.0）分，均P〈0.05]，联合组术后4 d联想学习评分低于对照组，组间差异有统计学意义[（10.9±2.2）分比（13.5±2.6）分，P〈0.05]。余认知功能项目评分术前术后及组间差异均无统计学意义（P〉0.05）。2组POCD发生率差异无统计学意义（P＞0.05）。结论按照本研究AHH的水平及CH的标准和时限，在有效保护血液的同时并未增加POCD的发生率。ObjectiveTo investigate the effects of acute hypervolemic hemodilution（AHH）combined with controlled hypotension（CH） on postoperative cognitive function in elderly patients receiving spinal surgery. MethodsSixty cases of spinal surgery in elderly patients from September 2010 to March 2012 were randomly divided into 2 groups（n=30）. All the patients in group H had mild AHH with 15 ml/kg 6% hydroxyethyl starch. At the same time nicardipine was infused and the mean arterial pressure（MAP） was maintained at 70% of the baseline. All patients in group C were as a control group. A set of six neuropsychological tests from the Wechsler Adult Intelligence Scale was administered on two occasions： 1st day before operation and 4th day after operation. ResultsFour days visual recognition was performed in the two groups. The score and the sign test score were statistically higher than those before operation [visual recognition was performed again for the group H： with score（15.9±3.5） vs （13.3±2.4）, and visual recognition was performed again for group C： with score（16.1±3.4） vs （12.0±2.7）; sign test was performed for the group H： with score（14.7±1.4） vs （12.8±1.7）,and sign test was performed for the group C： with score（15.8±2.2） vs （12.5±2.0）, both of which P〈0.05]. Differences of scores before and after operation between groups had no statistical significance （P〉0.05）. ConclusionAccording to the criteria and time limit of CH and the level of AHH, AHH combined with CH can effectively protect the blood without increasing the incidence of POCD.

关 键 词：脊柱手术 血液稀释 降压 控制性 认知功能 

分 类 号：R618.5[医药卫生—外科学]