急性高容量血液稀释对老年肺癌根治术患者术后认知功能和血浆S100β的影响

发布时间：2018-08-30 19:05

【摘要】：目的老年肺癌根治术应用广泛,文中探讨急性高容量血液稀释对老年肺癌根治术患者术后认知功能、血浆S100β的影响。方法选取华北理工大学附属医院2012年10月至2014年10月老年肺癌根治术患者112例,采用随机数字表法分为2组,稀释组(56例):患者实施急性高容量血液稀释。对照组(56例):患者未实施急性高容量血液稀释。采用简易精神状态量表(mini-mental state examination,MMSE)评定患者的认知功能,比较2组患者T0(麻醉诱导后即刻)、T1(血液稀释15 min)、T2(血液稀释60 min)、T3(手术结束前60 min)、T4(手术结束时)时间点脑氧代谢指标(血氧饱和度、血氧含量差、脑氧摄取率、乳酸差)、血浆S100β,以及术前、术后1、3、5、7 d的MMSE评分。结果 T1、T2、T3、T4时刻的稀释组患者血氧饱和度分别为(75.1±4.3)%、(78.5±3.1)%、(79.1±4.4)%、(79.6±2.8)%;血氧含量差、脑氧摄取率均随时间逐渐降低,与T0时刻比较差异均有统计学意义(P0.05);对照组血氧饱和度分别为(63.4±2.0)%、(63.9±1.8)%、(64.2±3.0)%、(64.7±3.2)%,组间同时间点比较,差异均有统计学意义(P0.05);T1、T2、T3、T4时刻的稀释组患者血浆S100β分别为(0.53±0.04)、(0.52±0.07)、(0.51±0.06)、(0.50±0.08)μg/L,对照组分别为(0.64±0.06)、(0.64±0.04)、(0.65±0.05)、(0.67±0.06)μg/L,组间同时间点比较的差异有统计学意义(P0.05)。术后1、3、5、7 d,稀释组MMSE评分分别为(24.3±1.7)、(26.5±1.9)、(27.8±1.3)、(28.1±1.0)分,对照组分别为(21.1±1.6)、(24.0±2.1)、(25.9±1.8)、(26.4±1.7)分,组间同时间点比较,稀释组MMSE评分均明显高于对照组(P0.05)。结论急性高容量血液稀释可明显改善老年肺癌根治术患者术后认知功能状况,降低血浆S100β,可能与脑氧代谢有关。
[Abstract]:Objective to investigate the effect of acute hypervolemic hemodilution on postoperative cognitive function and plasma S100 尾 in elderly patients with lung cancer. Methods 112 elderly patients undergoing radical resection of lung cancer from October 2012 to October 2014 in affiliated Hospital of North China University of Science and Technology were randomly divided into two groups: acute hypervolemic hemodilution was performed in the dilution group (56 cases). Control group (56 cases): acute hypervolemic hemodilution was not performed. Simple mental state scale (mini-mental state examination,MMSE) was used to evaluate the cognitive function of the patients. T0 (immediately after anesthesia induction) T _ 1 (hemodilution 15 min) / T _ 2 (hemodilution 60 min) T _ 3 (60 min before the end of operation) and T _ 4 (at the end of operation) were compared at the time points of cerebral oxygen metabolism (blood oxygen saturation, blood oxygen content difference, cerebral oxygen uptake rate). Lactic acid difference), plasma S 100 尾, and MMSE score of 5 days before and 1 day after operation. Results the blood oxygen saturation was (75.1 卤4.3), (78.5 卤3.1), (79.1 卤4.4), (79.6 卤2.8) in T _ 1T _ 2T _ 3 T _ 3 T _ 4 dilution group, respectively, and the difference of blood oxygen content and the rate of cerebral oxygen uptake gradually decreased with time, and the blood oxygen saturation was (75.1 卤4.3), (78.5 卤3.1), (79.1 卤4.4), (79.6 卤2.8), respectively. The blood oxygen saturation of the control group was (63.4 卤2.0), (63.9 卤1.8), (64.2 卤3.0), (64.7 卤3.2), respectively, and that of the control group was (63.4 卤2.0), (63.9 卤1.8), (64.7 卤3.2), respectively. There were significant differences in plasma S100 尾 between the dilution group (0.53 卤0.04), (, 0.52 卤0.07), (, 0.51 卤0.06), (, 0.50 卤0.08 渭 g / L) and the control group (0.64 卤0.06), (, 0.64 卤0.04), (0.65 卤0.05), (0.67 卤0.06) 渭 g / L, respectively (P0.05). The MMSE score of dilution group was (24.3 卤1.7), (26.5 卤1.9), (27.8 卤1.3), (28.1 卤1.0, and that of control group was (21.1 卤1.6), (24.0 卤2.1), (25.9 卤1.8), (26.4 卤1.7) at 7 days after operation. The MMSE score of dilution group was significantly higher than that of control group at the same time point (P0.05). Conclusion Acute hypervolemic hemodilution can significantly improve the cognitive function and decrease the plasma S100 尾 in elderly patients with lung cancer after radical resection, which may be related to cerebral oxygen metabolism.
【作者单位】：华北理工大学附属医院麻醉科;唐山市人民医院神经内科;
【基金】：唐山市科技计划项目(14130213a)
【分类号】：R614;R734.2

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