rSO_(2)为导向小剂量去甲肾上腺素对全麻髋关节置换术老年患者POCD的影响  

Effect of rSO_(2)-guided low-dose norepinephrine on postoperative cognitive dysfunction in elderly patients undergoing hip replacement under general anesthesia

作　　者：徐青荣 薄惠龙 李艳[2] 俞又佳 顾琴[2] Xu Qingrong;Bo Huilong;Li Yan;Yu Youjia;Gu Qin(Department of Anesthesiology,The Third Affiliated Hospital of Soochow University,Changzhou 213003,China;Department of Anesthesiology,Suzhou Xiangcheng People′s Hospital,Suzhou 215131,China)

机构地区：[1]苏州大学附属第三医院麻醉科,常州213003 [2]苏州市相城人民医院麻醉科,215131

出　　处：《中华麻醉学杂志》2021年第6期662-666,共5页Chinese Journal of Anesthesiology

基　　金：苏州市科技发展计划项目(SYSD2019062)。

摘　　要：目的:评价局部脑氧饱和度(rSO_(2))为导向小剂量去甲肾上腺素对全麻髋关节置换术老年患者术后认知功能障碍(POCD)的影响。方法:择期全麻下拟行髋关节置换术老年患者120例,性别不限,年龄65~80岁,体重指数18~24 kg/m^(2),ASA分级Ⅰ~Ⅲ级。采用随机数字表法分成2组(n=60):对照组(C组)和rSO_(2)为导向小剂量去甲肾上腺素组(RN组)。2组均行腹股沟上髂筋膜间隙阻滞联合喉罩置入全身麻醉。C组常规根据血压变化给予血管活性药物,维持MAP波动幅度不超过基础值20%,持续监测rSO_(2),但不以rSO_(2)变化率作为调节指标。RN组通过中心静脉持续泵注去甲肾上腺素0.01~0.10μg·kg^(-1)·min^(-1),根据rSO_(2)调节泵注去甲肾上腺素剂量,维持rSO_(2)变化率≤10%,并按需给予血管活性药物维持MAP波动幅度不超过基础值20%。于入室吸氧后(T_(0))、麻醉诱导后5 min(T_(1))、手术切皮后30 min(T_(2))、术毕(T_(3))和苏醒拔除喉罩(T_(4))时记录MAP、P ETCO_(2)和rSO_(2),并计算rSO_(2)变化率;记录术中血管活性药物使用情况及术后不良反应发生情况;于术前1 d和术后7 d使用蒙特利尔评分量表(MoCA)进行认知功能评分,Z计分法计算POCD发生情况。记录术后住院时间。结果:与C组比较,RN组T_(1),2时MAP和rSO_(2)升高,rSO_(2)变化率降低(P<0.05);与C组比较,RN组术中血管活性药物使用率减少,去甲肾上腺素用量增加,术后7 d时MoCA总分、注意和延迟回忆分项得分增加,POCD发生率降低,术后住院时间缩短(P<0.05)。结论:rSO_(2)为导向小剂量去甲肾上腺素可降低全麻髋关节置换术老年患者POCD的发生。Objective To evaluate the effect of regional oxygen saturation(rSO_(2))-guided low-dose norepinephrine on postoperative cognitive dysfunction(POCD)in elderly patients undergoing hip replacement under general anesthesia.Methods One hundred and twenty patients of both sexes,aged 65-80 yr,with body mass index of 18-24 kg/m^(2),of American Society of Anesthesiologists physical statusⅠ-Ⅲ,scheduled for hip replacement under general anesthesia,were divided into 2 groups(n=60 each)using a random number table method:control group(group C)and low-dose norepinephrine guided by rSO_(2) group(group RN).The patients in both groups received superior inguinal fascial space block combined with general anesthesia under laryngeal mask placement.In group C,the fluctuation range of mean arterial pressure(MAP)was not more than 20%of the baseline,vasoactive agents were administered according to the changes in blood pressure,rSO_(2) was monitored continuously,but the change rate of rSO_(2) was not used as the regulating index.In group RN,norepinephrine was infused continuously via the central vein at 0.01-0.10μg·kg^(-1)·min^(-1) after anesthesia induction,the dose was adjusted according to rSO_(2),the rSO_(2) change rate was maintained≤10%,the fluctuation range of mean arterial pressure was not more than 20%of the baseline,and vasoactive agents were administered when necessary.MAP,end-tidal pressure of carbon dioxide(PETCO_(2))and rSO_(2) were recorded after inhalation of oxygen(T_(0)),at 5 min after anesthesia induction(T_(1)),at 30 min after skin incision(T_(2)),at the end of surgery(T_(3))and after recovery and extubation(T_(4)),and the change rate of rSO_(2) was calculated.The occurrence of adverse events and amount of vasoactive drugs used were recorded.The cognitive function was assessed using Montreal Scale at 1 day before surgery and 7 days after surgery,and the development of postoperative cognitive dysfunction(POCD)was calculated using Z score.The postoperative hospital stay time was recorded.Results Compared with gro

关 键 词：去甲肾上腺素 麻醉 全身 关节成形术 置换 髋 老年人 认知障碍 脑氧饱和度 

分 类 号：R614[医药卫生—麻醉学]