预输注高渗盐溶液对老年患者术后谵妄的影响  

Effects of preconditioning with hypertonic saline solution on postoperative delirium in the aged

作　　者：信茜[1] 霍树平[1] 张琦[1] 李亚南[1] 王亮[1] 王秋筠[1] 

机构地区：[1]河北医科大学第三医院麻醉科,石家庄050051

出　　处：《中华医学杂志》2017年第39期3072-3078,共7页National Medical Journal of China

基　　金：国家自然科学基金（30972832）;临床医学优秀人才培养和基础课题研究项目计划（361005）

摘　　要：目的评价预输注高渗盐溶液对老年患者术后谵妄的影响。方法2016年6月至2017年2月，河北医科大学第三医院麻醉科择期行人工髋关节置换术患者120例，数字表法随机分为4组，每组30例。高渗氯化钠羟乙基淀粉40注射液组＋全身麻醉（H1组）、高渗氯化钠羟乙基淀粉40注射液组＋椎管内麻醉（H2组）、生理盐水组＋全身麻醉（c1组）和生理盐水组＋椎管内麻醉（C2组）。4组患者术前30min预输注高渗氯化钠羟乙基淀粉40注射液或生理盐水4ml／kg，H1、C1组行全身麻醉，H2、C2组行椎管内麻醉。于液体输注前（TO）、输注结束30min（T1）、60rain（T2）及120min（1’3）采取动脉血行血气分析，观察患者Na^＋、Ca^2＋、K^＋的变化趋势。于液体输注前（a0）、手术开始前（a1）、术中1h（a．2）、术后30min（03）和术后第2天（a4）抽取外周静脉血，检测血清中IL-1β、IL-6、TNF-α、IL-10及神经损伤标志物S100β蛋白含量，并于a0、a3及a4抽取外周静脉血流式细胞仪测定血单核细胞亚群CD14^＋CD16^＋表达水平。术后第1—3天行Nu．DESC评分测定患者是否发生谵妄。结果H组及C组Na^＋、Ca^2＋、K^＋均在正常范围内波动，与C组比较，H组T1、T2Na‘水平升高，K’水平降低（P〈0．05）；与液体输注前a0相比，四组术后IL-1β、IL-6及TNF-仪均升高（P〈0．05）；与H组同时点相比，c组术后血清中IL—1B、IL-6、TNF-旺及S100S升高，IL—10降低（P〈0．05）；与H1比较，H2各时点IL-1β、IL-6、TNF-α、IL-10及S100β差异元统计学意义（P〉0．05），同时CD14^＋CD16^＋单核细胞比例差异无统计学意义（P〉0．05）；与C组比较，H组术后各时点CD14^＋CD16^＋单核细胞比例表达减少，术后谵妄发生率降低（13．3％、10．0％比33．3％、36．7％，P〈0．05）。结论预输注高渗氯化钠羟乙基淀粉40注射液能够降低老年患者术后谵Objective To evaluate and explore the mechanism of the effect of hypertonic preinjection on postoperative delirium in the aged. Methods From June 2016 to February 2017, participants scheduled hip arthroplasty surgery were randomly divided into four groups ： Group 1 （ H1 ） 30 patients preinjected 4 ml/kg hypertonic solution were proceeded general anesthesia; Group 2 （H2） 30 patients preinjected 4 ml/kg hypertonic solution were proceeded spinal canal anesthesia; Group 3 （Cl） 30 patients preinjected 4 ml/kg isotonic saline were proceeded general anesthesia; Group 4 （C2） 30 patients pre-injected 4 ml/kg isotonic saline were proceeded spinal canal anesthesia in Department of Anesthesiology, Third Hospital of Hebei Medical University. All these patients were operated after anesthesia. To avoid electrolyte disorder, the level of Na^＋, Ca^2＋, K^＋ in the artery blood was analyzed. Peripheral venous blood was extracted to detect the concentration of inflammatory factors IL-1β, IL45, IL-10, TNF-α and nerve injury factor S100[$. In order to evaluate the relationship of these inflammatory fators with monocyte, we used flow cytometry to detect the number of mononuclear in peripheral venous blood. After operation 1 to 3 days, all these patients were assessed cognitive function by Nu-DESC. Results Electrolytes fluctuationed in the normal range in four groups at different time points. Compared with before infusion, IL-6, IL-1β and TNF-α of four groups were significantly increased in postoperative. Compared with group H（HI or H2）, IL-1β, IL- 6 and TNF-α were increased and IL-10 was decreased in group C （ C1 or C2） after the surgery. SI0013 of group C（ C1 and C2） was higher than before infusion. No significant changes were found in the cotykines mentioned above between group HI and H2. The expression of monocytes CD14^＋ CD16^＋/CD14^＋ was decreased and the incidence of postoperative delirium was lower in group H than group C（ 13.3%, 10. 0% vs 33.3% ,36. 7% ,P 〈 0.05）. Conclusion

关 键 词：高渗盐溶液 谵妄 老年人 免疫调节 

分 类 号：R614[医药卫生—麻醉学]