目标导向液体治疗对机器人辅助前列腺癌根治术老年患者术后认知功能的影响  

Effectof goal-directed fluid therapy on postoperative cognitive dysfunction after robot-assisted radical prostatectomy in the elderly

作　　者：袁柳青 梁伟东 李晓玲[1] 李盈 许厚仁[1] 钟茂林[1] YUAN Liuqing;LIANG Weidong;LI Xiaoling;LI Ying;XU Houren;ZHONG Maolin(Department of Anesthesiology,the First Affiliated Hospital of Gannan Medical University,Ganzhou 341000,China)

机构地区：[1]赣南医学院第一附属医院,江西赣州341000

出　　处：《现代医院》2023年第10期1571-1574,1579,共5页Modern Hospitals

基　　金：江西省卫生健康委员会科技计划项目(202210882)。

摘　　要：目的 观察目标导向液体治疗(goal-directed fluid therapy,GDFT)对老年患者在机器人辅助腹腔镜手术局部脑氧饱和度(rSO_(2))及术后认知功能(postoperative cognitive dysfunction,POCD)的影响。方法 采用临床随机对照试验,选择择期行机器人辅助腹腔镜下前列腺癌根治术老年患者(年龄在60到80岁)68例,均分为两组:常规容量治疗组(C组)和GDFT组(G组)。C组采用常规补液方案;G组采用Vigileo系统监测每搏量变异度(stroke volume variation,SVV)进行目标导向治疗。主要观察指标:采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)对两组患者术前1 d(D_(0))、术后1 d(D_(1))、术后3 d(D_(3))、术后7 d(D_(7))进行评分;次要观察指标:各时点视觉模拟评分(Visual Analogue Score,VAS)、血清S100β及IL-6水平;两组患者麻醉诱导前(T_(0))、气管插管后10min(T_(1))、Trendelenburg体位后30min(T_(2))、Trendelenburg体位后60min(T_(3))、术毕(T_(4))的血流动力学情况、乳酸值(lactic acid,Lac)及脑氧饱和度值(cerebral regional oxygen saturation,rSO_(2))。结果 两组患者MoCA在D_(1)、D_(3)均显著降低(P<0.05)。与C组比较,G组在D_(1)、D_(3)的MoCA显著升高(P<0.05)。与T_(0)比较,两组Lac、rSO_(2)在T_(1)降低,T_(2)、T_(3)、T_(4)均升高(P<0.05)。与D_(0)比较,两组IL-6、S100 β、VAS在D_(1)、D_(3)、D_(7)均升高(P<0.05);与C组比较,G组在D_(1)、D_(3)的血清IL-6、S100 β水平及VAS评分均降低(P<0.05)。结论 在SVV指导下的GDFT能够提高老年患者术后第一天(D_(0)),术后第三天(D_(3))MoCA评分,改善认知功能,降低POCD发生率(5%VS 13%),其机制可能与GDFT可降低血清IL-6及S100β水平并维持血流动力学稳定,改善组织器官的灌注有关。Objective To evaluate the effect of goal-directed fluid therapy(GDFT)on regional cerebral oxygen saturation(rSO2)and postoperative cognitive dysfunction(POCD)after robot-assisted radical propstatectomy in the elderly.Methods Sixty-eight patients undergoing robot-assisted radical propstatectomy,60 years of age and older,were randomly divided into 2 groups:routine fluid therapy group(group C)and GDFT group(group G).The strategy in group G is to maintain stroke volume variation(SVV)≤13%.Main observation indexes:The Montreal Cognitive Assessment(MoCA)were recorded in all patients before surgery(D0)and at 1,3 and 7 days postoperatively(D1,D3,D7).Secondary observations:The Visual Analogue Score(VAS),S100βprotein and serum IL-6 levels were recorded in all patients;The hemodynamics,lactic acid(Lac)and rSO2 were recorded in both groups before anesthesia induction(T0),10 min after endotracheal intubation(T1),30 min after Trendelenburg position(T2),60 min after Trendelenburg position(T3),and end of surgery(T4).Results The MoCA were significantly reduced at D1 and D3 in both groups(P<0.05).Compared with group C,the MoCA were significantly increased at D1 and D3 in group G(P<0.05).Compared with T0,the Lac and rSO2 were decreased at T1,and increased at T2,T3 and T4(P<0.05).Compared with D0,the IL-6,S100βand VAS were increased at D1,D3 and D7(P<0.05).Compared with group C,the serum IL-6,S100βlevels and VAS scores were reduced at D1 and D3 in group G(P<0.05).Conclusion GDFT guided with SVV can improve MoCA scores on the first day(D1)and the third day(D3),improve the cognitive function and reduce the incidence of POCD in elderly patients undergoing robot-assisted radical prostatectomy.And its mechanism may be related to the decreases of serum S100βand IL-6 and maintain the effective circulating blood volume and systemic perfusion.

关 键 词：脑氧饱和度 每博量变异 机器人 老年 液体治疗 认知功能 

分 类 号：R197[医药卫生—卫生事业管理]