术中血流动力学变化对高龄患者早期术后认知功能障碍发病率的影响

发布时间：2019-02-14 17:15

【摘要】：目的了解术中血流动力学变化对高龄患者早期术后认知功能障碍(POCD)发病率的影响。方法选择择期在气管插管全凭静脉麻醉下手术的高龄患者200例,根据术后1 w内认知功能判定,将其分为POCD组36例及非POCD组164例。统计两组麻醉前10 min、麻醉后10、30、60 min及手术结束时的平均动脉压(MAP)、心率(HR)、收缩压与HR的乘积(RPP)、中心静脉压(CVP)、脉搏氧饱和度(Sp O2)、心输出量(CO)、每搏输出量(SV)等血流动力学指标值,对血流动力学变化等潜在风险因素与POCD相关性进行评估。结果于麻醉后30、60 min及手术结束时,MAP、HR、RPP、CO、SV值POCD组明显高于麻醉前10 min和非POCD组(P0.05):Logistic回归分析显示,术中MAP、HR、RPP、CO、SV 5个因素是早期POCD的危险因素。结论术中MAP升高、HR增快、RPP增加、CO增加、SV增加这5个因素是早期POCD的危险因素,维持术中血流动力学相对稳定可降低早期POCD的发病率。
[Abstract]:Objective to investigate the effect of intraoperative hemodynamic changes on the incidence of cognitive dysfunction (POCD) in elderly patients. Methods 200 elderly patients undergoing tracheal intubation under total intravenous anesthesia were selected and divided into POCD group (n = 36) and non-POCD group (n = 164) according to their cognitive function within 1 week after operation. The mean arterial pressure, (MAP), heart rate, (HR), systolic pressure and HR product (RPP), central venous pressure (Sp O 2), cardiac output (CO), (CVP), pulse oxygen saturation (Sp O 2), cardiac output (CO),) were calculated in both groups 10 min, before anesthesia and 60 min after anesthesia, and the mean (MAP), heart rate (HR), systolic pressure at the end of the operation and the HR product (RPP), central venous pressure. The potential risk factors such as hemodynamic changes, such as (SV), were evaluated for their correlation with POCD. Results at 30 ~ 60 min after anesthesia and at the end of operation, the MAP,HR,RPP,CO,SV value of POCD group was significantly higher than that of 10 min before anesthesia and non-POCD group (P0.05): Logistic regression analysis showed that the MAP,HR,RPP,CO, during operation was significantly higher than that in POCD group). Five factors of SV were risk factors of early POCD. Conclusion the increase of MAP, the increase of HR, the increase of RPP, the increase of CO and the increase of SV are the risk factors of early POCD. Maintaining the relative stability of hemodynamics during operation can reduce the incidence of early POCD.
【作者单位】：大连医科大学附属第一医院麻醉科;大连医科大学附属第一医院神经电生理科;
【基金】：大连市科技计划项目课题资助(No.2012E15SF161)
【分类号】：R614

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