预先输注高渗盐水对老年患者术后认知功能的影响  

Effect of pre-infusion of hypertonic saline on postoperative cognitive function in elderly patients

作　　者：徐芳[1] 王旭鹏 李亚南[1] 张亚辉[1] 周琦 高明阳 胡宇菲 任小芹 王秋筠[1] Xu Fang;Wang Xupeng;Li Yanan;Zhang Yahui;Zhou Qi;Gao Mingyang;Hu Yufei;Ren Xiaoqin;Wang Qiujun(Department of Anesthesiology,Hebei Medical University Third Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第三医院麻醉科,石家庄050000

出　　处：《中华麻醉学杂志》2024年第10期1186-1189,共4页Chinese Journal of Anesthesiology

基　　金：河北省自然科学基金精准医学联合基金重点项目(H2021206021)。

摘　　要：目的评价预先输注高渗盐水对老年患者术后认知功能的影响。方法本研究为前瞻性研究。选择本院2022年6月至2023年1月择期行臂丛阻滞联合全身麻醉下肩关节镜手术患者76例,性别不限,年龄≥60岁,ASA分级Ⅱ级或Ⅲ级,采用随机数字表法分为2组(n=38):高渗盐水组和生理盐水组。于麻醉诱导前30 min时,高渗盐水组静脉输注3%高渗盐水4 ml/kg,生理盐水组静脉输注生理盐水4 ml/kg。记录术中脑去饱和事件(CDEs)的发生情况。术后24 h时采集静脉血标本,采用ELISA法测定血浆IL-1β、IL-6、TNF-α和S-100β的浓度,采用流式细胞仪检测中性粒细胞CD11b表达水平。分别于术前1 d和术后5 d行听觉词语学习测试、连线测验、数字符号替换测试和Stroop色词测试,采用Z计分法评估术后认知功能障碍的发生情况。结果与生理盐水组比较,高渗盐水组血浆IL-6、TNF-α和S-100β浓度及中性粒细胞CD11b表达水平降低,认知功能障碍发生率和CDEs发生率降低(P<0.05)。结论预先输注高渗盐水可减轻炎症反应,改善老年患者术后认知功能。Objective:To evaluate the effect of pre-infusion of hypertonic saline on the postoperative cognitive function in elderly patients.Methods:This was a prospective study.Seventy-six patients of both sexes,aged≥60 yr,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,who underwent elective shoulder arthroscopic surgery under brachial plexus block combined with general anesthesia from June 2022 to January 2023 in our hospital,were selected and divided into 2 groups(n=38 each)by the random number table method:hypertonic saline group and normal saline group.At 30 min before anesthesia induction,3%hypertonic saline of 4 ml/kg was intravenously infused in hypertonic saline group,and normal saline 4 ml/kg was intravenously infused in normal saline group.The occurrence of intraoperative cerebral desaturation events was recorded.Venous blood samples were collected at 24 h postoperatively,and the plasma concentrations of interleukin-1beta(IL-1β),IL-6,tumor necrosis factor-alpha and S-100βwere measured by enzyme-linked immunosorbent assay,and the expression of neutrophil CD11b was detected by flow cytometry.Rey auditory verbal learning test,trail making test,digit symbol substitution test,and stroop color-word test were performed at 1 day before surgery and 5 days after surgery,and the postoperative cognitive dysfunction was assessed using the Z-score method.Results:Compared with normal saline group,the concentrations of plasma IL-6,tumor necrosis factor-alpha and S-100βand expression of neutrophil CD11b were significantly decreased in hypertonic saline group,and the incidence of cognitive dysfunction and cerebral desaturation events was decreased in hypertonic saline group(P<0.05).Conclusions:Pre-infusion of hypertonic saline can reduce inflammatory responses and improve postoperative cognitive function in elderly patients.

关 键 词：盐水 高渗 术后认知并发症 老年人 

分 类 号：R614[医药卫生—麻醉学]