目标导向容量治疗对老年结直肠癌根治术病人术后认知功能障碍的影响  

The effect of goal-directed fluid therapy on postoperative cognitive dysfunction in elderly patients undergoing colorectal carcinoma radical surgery

作　　者：张亚飞[1] 吴超[1] 肖骥峰 ZHANG Yafei;WU Chao;XIAO Jifeng(Department of Anesthesiology,904th Hospital of Joint Logistics Support Force,PLA,Jiangsu,Wuxi 214000,China)

机构地区：[1]中国人民解放军联勤保障部队第九○四医院麻醉科,江苏无锡214000

出　　处：《临床外科杂志》2020年第4期370-373,共4页Journal of Clinical Surgery

基　　金：江苏省卫生计生委2016年度青年科研课题资助项目(Q201611)。

摘　　要：目的探讨目标导向容量治疗对老年结直肠癌根治术病人术后认知功能障碍(POCD)的影响。方法 2014年2月~2018年2月收治的结直肠癌根治术老年病人98例。使用SPSS17.0软件生成随机序列号,随机分配至目标导向容量治疗组(GDFT组)和对照组(Con组),每组各49例。桡动脉穿刺置管并连接Vigileo-FloTrac系统监测每搏变异度(SVV)。GDFT组于SVV指导下行目标导向容量治疗;Con组病人则采用传统方式进行补液。术前1天、术后1天、术后3天、术后1周、术后1个月、术后3个月、术后6个月评估病人MMSE评分并结合1SD原则诊断术后认知功能障碍。于术前1天、术后1天、术后3天、术后1周抽取外周静脉血检测S100β蛋白、神经元特异性烯醇化酶(NSE)。结果 GDFT组病人与Con组病人术后1天、术后3天、术后1周、术后1个月、术后3个月、术后6个月POCD发生率分别为30.6%和57.1%、28.6%和55.1%、22.4%和51.0%、16.7%和42.6%、17.4%和39.1%、15.6%和36.4%,两组比较差异有统计学意义(P<0.05)。GDFT组和Con组病人术前1天S100β蛋白浓度分别为(121.4±13.4)pg/ml和(122.3±11.6)pg/ml,NSE浓度分别为(6.8±1.1)ng/ml和(7.0±1.2)ng/ml,两组比较差异无统计学意义(P> 0.05)。GDFT组和Con组病人术后1天、术后3天、术后1周S100β蛋白浓度分别为(206.6±18.7)pg/ml和(231.5±17.3)pg/ml、(191.8±14.6)pg/ml和(217.9±15.8)pg/ml、(171.5±13.3)pg/ml和(195.7±16.2)pg/ml,NSE浓度分别为(19.4±1.6)ng/ml和(24.7±2.1)ng/ml、(17.3±1.8)ng/ml和(22.0±2.3)ng/ml、(15.9±1.8)ng/ml和(20.6±2.0)ng/ml,两组比较差异有统计学意义(P<0.05)。结论目标导向容量治疗能够降低结直肠癌根治术老年病人术后6个月内认知功能障碍发生率。Objective To evaluate the effect of goal-directed fluid therapy on postoperative cognitive dysfunction in elderly patients undergoing colorectal carcinoma radical surgery.Methods 98 patients undergoing colorectal carcinoma radical surgery,were randomly divided into goal-directed fluid therapy group(GDFT group)and control group(Con group)by random sequences generated by SPSS 17.0,49 cases in each group.The radial artery puncture catheter was connected to the Vigileo-FloTrac system for monitoring stroke volume variation(SVV).Fluid infusion was guided by goal-directed fluid therapy based on SVV in GDFT group.Conventional therapy was used in Con group.The MMSE score was assessed at 1 day before surgery,1 day,3 days,1 week,1 month,3 months and 6 months after surgery,and the postoperative cognitive dysfunction was diagnosed with 1 SD principle.Peripheral venous blood was extracted at 1 day before surgery,1 day,3 days and 1 week after surgery for the detection of S100 immunoglobulin and neuron-specific enolase(NSE).Results The incidence of POCD in the GDFT group at 1 day after surgery(30.6%/57.1%),3 days after surgery(28.6%/55.1%),1 week after surgery(22.4%/51.0%),1 month after surgery(16.7%/42.6%),3 months after surgery(17.4%/39.1%)and 6 months after surgery(15.6%/36.4%) was significantly lower than that in the Con group,with statistically significant differences(P<0.05).There was no statistically significant difference in S100 serum protein [(121.4±13.4)pg/ml and(122.3±11.6)pg/ml] and NSE [(6.8±1.1)ng/ml and(7.0±1.2)ng/ml] concentrations between the two groups at 1 day before surgery(P>0.05).The concentration of S100 [(206.6±18.7)pg/ml and(231.5±17.3)pg/ml],[(191.8±14.6)pg/ml and(217.9±15.8)pg/ml],[(171.5±13.3)pg/ml and(195.7±16.2)pg/ml] and NSE [(19.4±1.6)ng/ml and(24.7±2.1)ng/ml],[(17.3±1.8)ng/ml and(22.0±2.3)ng/ml],[(15.9±1.8)ng/ml and(20.6±2.0)ng/ml] in the GDFT group at 1 day after surgery,3 days after surgery and 1 week after surgery was significantly lower than that in the Con group(P<0.05).Conc

关 键 词：目标导向容量 结直肠癌根治术 术后认知功能障碍 老年 

分 类 号：R614[医药卫生—麻醉学]