术中不同液体管理对腹腔镜重大手术患者术后认知功能的影响  

Effects of different fluid treatments on postoperative cognitive dysfunction in patients undergoing major laparoscopic surgery

作　　者：林静[1] 赵佳诗 LIN Jing;ZHAO Jiashi(Department of Anesthesiology,First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院麻醉科,浙江温州325000

出　　处：《中国现代医生》2023年第6期30-34,共5页China Modern Doctor

摘　　要：目的探讨术中不同的液体治疗对腹腔镜重大手术患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)短期并发症的影响。方法回顾性分析2021年3至11月温州医科大学附属第一医院所有行腹腔镜重大手术的499例手术患者的临床资料,根据患者术中补液方式分为目标导向性液体治疗组(GDFT组)160例,限制补液组(RFT组)150例,及自由补液组(LFT组)189例,根据病历收集患者基本情况及术前合并症,术后患者简易精神状态检查(mini-mental state examination,MMSE)评分(病区护士提供),术后并发症及住院时间。根据麻醉记录单收集术中补液情况,尿量出血量、术中血压、心率及手术时间,评估麻醉术中液体治疗对患者术后认知功能及预后的影响。结果GDFT组在3组患者中POCD发生率最低,差异有统计学意义(P<0.05)。GDFT组和RFT组住院天数与LFT比较,差异均有统计学意义(P<0.05)。总的术后并发症(包括POCD)发生率,GDFT组最低,差异有统计学意义(P<0.05),LFT组术后感染率在3组患者中发生率最高,差异有统计学意义(P<0.05)。余患者基础情况、年龄、手术时间、术中出血、术中尿量等,差异均无统计学意义(P>0.05),LFT组术中晶体平均输入高于RFT组及GDFT组,差异有统计学意义(P<0.05),余胶体及血制品输入差异均无统计学意义(P>0.05)。另3组术后碱剩余,术后乳酸及术前术后肌酐、尿素差,差异均无统计学意义(P>0.05)。结论对于重大腹腔镜手术的患者,目标导向性补液能减少患者POCD发生率,减少并发症的发生,改善预后,且不会增加急性肾损伤发生率,不增加组织低灌注及细胞缺血缺氧的风险。Objective To evaluate the postoperative cognitive dysfunction and short-term clinical outcomes of different intraoperative fluid therapy in major laparoscopic surgery.Methods The incidence of postoperative cognitive dysfunction(POCD)in GDFT group was the lowest among the three groups,and the difference was statistically significant(P<0.05).The hospitalization days of GDFT group and RFT group were significantly different from those of LFT group and the difference was statistically-significant(P<0.05).The total incidence of postoperative complications(including POCD)was the lowest in the GDFT group,and the difference was statistically significant(P<0.05).The incidence of postoperative infection in the LFT group was the highest in the three groups,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the basic condition,age,operation time,intraoperative bleeding,intraoperative urine volume,etc.of the remaining patients(P>0.05)There was no significant difference in the remaining alkali,lactic acid,creatinine and urea in the other three groups(P<0.05).Conclusion For patients undergoing major laparoscopic surgery,GDFT can reduce the incidence of postoperative cognitive dysfunction,reduce the incidence of complications,and does not increase the incidence of acute kidney injury(AKI),or increase the risk of tissue hypoperfusion and cell ischemia and hypoxia.

关 键 词：术后认知功能障碍 目标导向性液体治疗 腹腔镜重大手术 

分 类 号：R614[医药卫生—麻醉学]