目标导向液体治疗对老年髋部骨折患者术后谵妄的影响  

The Effect of Goal-Directed Fluid Therapy on Postoperative Delirium in Elderly Patients with Hip Fractures

作　　者：刘燕 张文超 董晶晶 温哲 贾晋太[1] LIU Yan;ZHANG Wenchao;DONG Jingjing(Department of anesthesiology, Heping Hospital affiliated to Changzhi medical college)

机构地区：[1]长治医学院附属和平医院麻醉科,046000 [2]北京大学第四临床学院(北京积水潭医院)麻醉科

出　　处：《长治医学院学报》2021年第6期431-435,共5页Journal of Changzhi Medical College

摘　　要：目的:探讨目标导向液体治疗(GDFT)对老年髋部骨折患者术后谵妄(POD)的影响。方法:选择择期行椎管内麻醉下髋部骨折手术的老年患者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),每组各30例。G组给予患者胶体冲击,C组给予常规补液。观察并记录在蛛网膜下腔阻滞前(T_(0))、蛛网膜下腔阻滞后5 min(T_(1))、手术开始前(T_(2))、手术5 min(T_(3))、手术30 min(T_(4))5个不同时段平均动脉压(MAP)、每搏输出量(SV)、心输出量(CO)变化,比较2组患者术后1 d及术后3 d简易精神智能状态量表(MMSE)评分。结果:2组患者在T_(1)时刻MAP和CO明显下降,且C组明显低于G组[(69.40±8.00)vs(79.00±8.31)mmHg,(3.32±0.84)vs(3.67±0.55)L·min^(-1)],差异有统计学意义(P<0.05);2组患者在T_(2)、T_(3)时刻SV明显升高,且G组明显高于C组[(65.71±12.12)vs(57.00±12.81)mL,(65.30±11.17)vs(56.93±12.71)mL],差异有统计学意义(P<0.05);G组患者晶体液、胶体液入量和输液总量明显低于C组,差异有统计学意义(P<0.05);去甲肾上腺素使用例数和出血量差异无统计学意义(P>0.05)。2组术后1 d及3 d MMSE评分下降,且G组高于C组,但差异无统计学意义。结论:老年髋部骨折手术实施椎管内麻醉过程中,应用目标导向液体治疗靶向补液优化心输出量,维持循环稳定,能够改善老年患者术后短期内认知功能。Objective:To observe the effect of goal-directed fluid therapy on postoperative delirium in hip elderly patients.Methods:60 elderly patients who underwent surgery for hip fracture under spinal anesthesia were randomly divided into two groups:goal-directed fluid therapy group(G group)and routine fluid group(C group),with 30 patients in each group.Patients in group G were given the colloidal solution as impact therapy,while patients in Group C conducted the intraoperative fluid infusion according to the classical transfusion regimen.Mean arterial pressure(MAP),stroke volume(SV)and cardiac output(CO)before subarachnoid block(T_(0)),at 5 min after subarachnoid block(T_(1)),before surgery(T_(2))and at 5min after surgery(T_(3)),and 30min after surgery(T_(4))were recorded.The simple mental state scale(MMSE)scores were performed 1 day after surgery and 3 days after surgery to evaluate patient’s cognitive function.Results:MAP and CO at T_(1) in the two groups was decreased significantly,and the C group was significantly lower than G group[(69.40±8.00)vs(79.00±8.31)mmHg,(3.32±0.84)vs(3.67±0.55)L·min^(-1)],and the difference was statistically significant(P<0.05).SV at T_(2),T_(3) in the two groups was increased significantly,and group G was significantly higher than group C[(65.71±12.12)vs(57.00±12.81)mL,(65.30±11.17)vs(56.93±12.71)mL],and the difference was statistically significant(P<0.05).The number of crystal solution volume,colloidal solution volume and total intake in Group G were significantly lower than that in Group C,the difference was statistically significant(P<0.05).The number of norepinephrine use and the amount of bleeding in the two groups was no statistically significant(P>0.05).MMSE in the two groups was decreased 1d and 3d after surgery,and the scores of group G was higher than group C,but the difference was not statistically significant.Conclusion:In the elderly patients with hip joint replacement surgery under spinal anesthesia,goal-directed fluid therapy can make the intraoperative fluid man

关 键 词：目标导向液体治疗 老年髋部骨折 椎管内麻醉 术后谵妄 

分 类 号：R643.4[医药卫生—外科学]