目标导向液体治疗对老年高血压患者行控制性降压鼻内镜手术术后谵妄的影响  

Influence of Goal-directed Fluid Therapy on Postoperative Delirium after the Controlled Hypotension of Endoscopic Sinus Surgery in Elderly Patients with Hypertension

作　　者：曾凯[1] 梁敏[1] 杨晨 李艳珍[1] 林献忠[1] 林财珠[1] ZENG Kai;LIANG Min;YANG Chen;LI Yanzhen;LIN Xianzhong;LIN Caizhu(Department of Anesthesiology,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院麻醉科,福州350005

出　　处：《福建医科大学学报》2018年第6期408-415,共8页Journal of Fujian Medical University

基　　金：福建省中青年教师教育科研项目(JAT170243)

摘　　要：目的探讨通过观察目标导向液体治疗(GDFT)对老年高血压患者行控制性降压鼻内镜手术(ESS)围手术期血流动力学、组织灌注及炎症因子的影响及对其术后谵妄(POD)的影响。方法选择原发性高血压病老年患者(≥65岁)、择期行ESS手术者60例,随机分为目标导向液体治疗组(G组)和常规液体治疗组(C组),观察2组患者手术前30 min(T_0)、手术开始(T_1)、手术开始后1 h(T_2)、术毕(T_3)、术后6 h(T_4)、术后12 h(T_5)、术后24 h(T_6)血流动力学、组织灌注、脑氧饱和度及炎症因子等指标,于术后24,48,72 h通过谵妄等级评定量表-修正版评定POD的发生率,统计术后并发症情况以及术后住院时间。结果与C组比较,G组术中及术后血流动力学更稳定,低血压事件的发生例数更少(P<0.05);G组术中总输液量更少[(1 465±308)mL vs(1 879±496)mL,P<0.05],胶体输液量增多[(758±160)mL vs(304±145)mL,P<0.05];G组的POD发生率为6.67%,C组为33.33%,差别有统计学意义(P<0.05);2组近期并发症(如肺部感染、肺水肿、心力衰竭等)、死亡率及脑血管意外等方面比较,差别无统计学意义(P>0.05);但G组住院时间更短[(5.2±1.3)d vs(7.5±1.5)d,P<0.05]。结论 GDFT对老年高血压病患者行控制性降压鼻内镜手术可以稳定患者围术期血流动力学,改善组织灌注,减轻炎症反应,降低POD的发生率,缩短住院日。Objective To investigate the influence of perioperative goal-directed fluid therapy(GDFT)on postoperative delirium after the controlled hypotension of endoscopic sinus surgery in elderly patients with hypertension.Methods Sixty elderly patients(≥65 years old)with primary hypertension who underwent controlled hypotension of endoscopic sinus surgery.Selected patients were divided randomly into two arms,comprising a conventional intraoperative fluid management arm(arm C,n=30)and a GDFT arm(arm G,n=30).Hemodynamics,tissue perfusion laboratory indicators,cerebral oxygen saturation,and inflammatory of all patients were observed and recorded respectively at 30 min before the operation(T 0),the beginning of the operation(T 1),1 h after the beginning of operation(T 2),the end of the operation(T 3),6 h after the operation(T 4),12 h after the operation(T 5),and 24 h after the operation[JP2](T 6).Postoperative delirium was assessed by delirium rating scale-revised-98[JP]at 24 h after the operation,[JP]48 h after the operation,and 72 h after the operation.Postoperative complications and hospital stay after operation were also recorded.Results Compared with arm C,there were more patients exhibiting intraoperatively and postoperatively stable hemodynamics and less patients with low blood pressure in arm G(P<0.05).In addition,the average intraoperative intravenous infusion quantity in arm G was significantly reduced[(1 465±308)mL vs(1 879±496)mL,P<0.05],whereas average colloid fluid volume was significantly increased[(758±160)mL vs(304±145)mL,P<0.05].Significant differences were observed in postoperative delirium between the two arms,which in arm G was 6.67%,in arm C was 33.33%.No significant difference in mortality and cerebrovascular accident,such as pulmonary infection,pulmonary edema,and heart failure,was observed between the two groups.However,shorter stay of postoperative inpatients[(5.2±1.3)d vs(7.5±1.5)d,P<0.05]was also observed in arm G.Conclusion Our research showed that GDFT stabilized perioperative hemodynami

关 键 词：补液疗法 老年人 内窥镜检查 耳鼻咽喉科学 高血压 降压 控制性 

分 类 号：R459.3[医药卫生—治疗学] R76[医药卫生—临床医学]