目标导向液体治疗对老年下肢骨折开放复位内固定手术者的MAP、NT-proBNP及hs-CRP的影响  

Effects of target-guided fluid therapy on MAP,NT-proBNP,and hs-CRP in elderly patients undergoing open reduction and internal fixation for lower limb fractures

作　　者：程南[1] 沈迎雁 郑卫国[1] 华有盛 CHENG Nan;SHEN Yingyan;ZHENG Weiguo(Department of Anesthesiology,Zhejiang Quhua Hospital,Quzhou 324004,China)

机构地区：[1]浙江衢化医院麻醉科,浙江衢州324004

出　　处：《全科医学临床与教育》2022年第3期218-221,共4页Clinical Education of General Practice

基　　金：衢州市科技项目(2018ASA90248)。

摘　　要：目的探讨目标导向液体治疗(GDFT)对老年下肢骨折开放复位内固定手术者的平均动脉压(MAP)、N-末端脑钠肽前体(NT-proBNP)及超敏C反应蛋白(hs-CRP)的影响。方法选取80例下肢骨折开放复位内固定手术患者,随机分为实验组和对照组,各40例,分别接受(GDFT)治疗和常规液体治疗,比较两组患者在术前(T_(1))、手术开始(T_(2))及术毕(T_(3))时刻的MAP及血清NT-proBNP、hs-CRP水平。结果实验组T_(1)~T_(3) MAP逐渐升高,血清NTproBNP、hs-CRP逐渐降低,差异均有统计学意义(F分别=12.83、68.59、6.40,P均<0.05);对照组T_(1)~T_(3) MAP逐渐升高,血清NT-proBNP逐渐降低(F分别=6.27、5.80,P均<0.05),但hs-CRP无明显变化(F=0.55,P>0.05)。实验组患者T_(2)、T_(3)时MAP较对照组明显升高,差异均有统计学意义(t分别=5.50、9.89,P均<0.05),血清NT-proBNP及hs-CRP较对照组明显降低,差异均有统计学意义(t分别=-5.77、-10.58、-2.03、-2.74,P均<0.05)。结论GDFT治疗可以提高老年下肢骨折开放复位内固定手术者MAP水平,降低血清NT-proBNP、hs-CRP水平,改善和预防该类患者不稳定的血流动力学状态。Objective To investigate the effect of target-directed fluid therapy on map,NT-proBNP and hs CRP in elderly patients with lower limb fractures undergoing open reduction and internal fixation.Methods Totally 80 patients with lower limb fractures were randomly divided into experimental group and control group,with 40 patients in each group.The patients in experimental group were received target oriented liquid therapy and the patients in control group were received routine liquid therapy.The levels of MAP,serum NT-proBNP,and hs-CRP were measured in the two groups at preoperative(T_(1)),the beginning(T_(2))and the end of operation(T_(3)).Results In the experimental group,the MAP increased gradually,and serum NT-proBNP and hs-CRP decreased gradually from T_(1) to T_(3).The differences were statistically significant(F=12.83,68.59,6.40,P<0.05).In the control group,the MAP gradually increased while the serum NT-pro-BNP gradually decreased from T_(1) to T_(3)(F=6.27,5.80,P<0.05),but the hs-CRP had no significant change(F=0.55,P>0.05).The MAP of patients in the experimental group at T_(2) and T_(3) was significantly higher than that in the control group(t=5.50,9.89,P<0.05),and the serum NT-proBNP and hs CRP were significantly lower than those in the control group(t=-5.77,-10.58,-2.03,-2.74,P<0.05).Conclusion Target-guided fluid therapy can improve MAP level and reduce serum NT-proBNP and hs-CRP level in elderly patients with lower extremity fracture undergoing open reduction and internal fixation,which suggests that it can improve and prevent the unstable hemodynamic status of these patients.

关 键 词：目标导向液体治疗 下肢骨折手术 平均动脉压 N-末端脑钠肽前体 超敏C反应蛋白 

分 类 号：R614[医药卫生—麻醉学]