改良目标导向液体疗法预防高龄骨科下肢手术早期术后认知功能障碍的观察  

Improved Perioperative Goal-directed Fluid Therapy for the Prevention of Early Postoperative Cognitive Impairment for Lower Extremity Surgery in Elderly Orthopaedic Patients

作　　者：代景伟[1] 陈振毅[1] 洪丽琼[1] 冯宇峰[1] 林梁[1] DAI Jingwei;CHEN Zhenyi;Hong Liqiong;FENG Yufeng;LIN Liang(Department of Anesthesiology,The First Affiliated Hospital of Xiamen University,Xiamen Fujian 361022,China)

机构地区：[1]厦门大学附属第一医院麻醉科,福建厦门361022

出　　处：《中国卫生标准管理》2018年第22期119-121,共3页China Health Standard Management

摘　　要：目的探讨改良目标导向液体疗法对高龄骨科下肢手术患者早期术后认知功能障碍的影响。方法择期手术ASAⅠ～Ⅱ级75岁以上高龄患者60例随机分成两组(n=30),A组(对照组)术中予目标导向液体疗法(GDFT)治疗;B组(实验组)术中予改良GDFT治疗。以每搏量变异度(SVV)作为主要指标判断容量负荷。治疗中持续泵注垂体后叶素0.000 4 u/kg/min～0.001 5 u/kg/min并根据血压调整剂量。观察并记录患者术前1 d,术后1 d,4 d,7 d,认知功能障碍(POCD)发生例数。结果 POCD发生例数(%),术后1 d,4 d,7 d,B组少于A组(P <0.01)。结论改良GDFT对高龄骨科下肢手术患者的早期术后认知功能障碍有预防作用。Objective To explore the effect of improved perioperative goal-directed fluid therapy on early postoperative cognitive disfunction in patients with lower extremity surgery.Methods To elective surgery patients 60 cases aged more than 75 year of ASA physical statusⅠ~Ⅱwere randomly divided into two groups.Group A(control group)in the perioperative goal-directed fliud therapy(GDFT)liquid transfusion treatment;Group B(experimental group),intraoperative be improved perioperative goal-directed fluid therapy.The capacity load was judged as the main index with strock volume variation(SVV).In treatment,the hypophysin was 0.000 4 u/kg/min^0.001 5 u/kg/min continuously pumped and the dosage was adjusted according to blood pressure.To observe and record the cases of postoperative cognitive disfunction(POCD)in preoperative 1 d,postoperative 1 d,4 d,7 d.Results The number of cases postoperative cognitive disfunction(%)is group B less than the group A in postoperative 1 d,4 d,7 d(P<0.01).Conclusion The improved perioperative goal-directed fluid therapy for lower extremity surgery of elder patient orthopaedics in early postoperative cognitive dysfunction has significant preventive action.

关 键 词：术后认知障碍 目标导向液体疗法 每搏量变异度 脑灌注 多巴酚丁胺 垂体后叶素 

分 类 号：R614[医药卫生—麻醉学]