瑞芬太尼控制性降压对老年脊柱手术患者术后认知功能障碍和血清S100β蛋白的影响及二者相关性分析

发布时间：2019-03-11 18:16

【摘要】：目的;观察瑞芬太尼控制性降压(CH)对老年脊柱手术患者术后认知功能障碍(POCD)和血清SlOOβ蛋白的影响,并考察二者的相关性。方法:前瞻性选择2014年1月-2015年12月我院骨科拟择期全身麻醉下行腰椎或胸椎骨折椎板减压内固定术的老年患者60例,采用随机数字表法分为CH组与非CH组,各30例。两组患者均采用气管内插管静脉吸入复合全身麻醉;CH组患者通过调整盐酸瑞芬太尼泵注速率,使平均动脉压(MAP)降至基础值的70%~80%;非CH组则维持MAP基础值。观察两组患者手术时间、麻醉时间、术中失血量、术后POCD发生率、血清S100β蛋白浓度,分析血清S100β蛋白浓度与POCD发生率的相关性,并记录不良反应发生情况。结果:CH组患者术中失血量明显少于非CH组,差异有统计学意义(P0.05)。两组患者术后第1、7天POCD发生率比较,差异无统计学意义(P0.05);CH组患者术后第2、3天POCD发生率和血清S100β蛋白浓度均明显高于非CH组,差异均有统计学意义(P0.05)。患者的POCD发生率可能与血清S100β蛋白浓度存在相关性(r=0.992 7,P=0.001 3)。结论:瑞芬太尼CH用于老年脊柱手术患者,可减少术中失血量,但增加了血清S100β蛋白浓度且升高了术后早期POCD发生率。
[Abstract]:Aim: to observe the effect of remifentanil-controlled hypotensive (CH) on cognitive dysfunction (POCD) and serum SlOO-尾 protein in aged patients after spinal surgery, and to investigate the correlation between remifentanil and remifentanil. Methods: from January 2014 to December 2015, 60 elderly patients with lumbar or thoracic fracture were prospectively divided into CH group and non-CH group (30 cases in each group) under general anesthesia for decompression and internal fixation of lumbar or thoracic vertebral fractures. The patients were randomly divided into two groups: one group (n = 30) and the other group (n = 30, n = 30). The mean arterial pressure (MAP) was reduced to 70% / 80% of the basic value in the CH group by adjusting the infusion rate of remifentanil hydrochloride, while the MAP basal value was maintained in the non-CH group. The operative time, anesthesia time, intraoperative blood loss, postoperative POCD incidence and serum S100 尾 protein concentration were observed. The correlation between the serum S100 尾 protein concentration and the incidence of POCD was analyzed, and the incidence of adverse reactions was recorded. Results: the amount of blood loss in CH group was significantly lower than that in non-CH group (P0.05). There was no significant difference in the incidence of POCD between the two groups on the 1st and 7th day after operation (P0.05). The incidence of POCD and the concentration of serum S100 尾 protein on the 2nd and 3rd day after operation in the); CH group were significantly higher than those in the non-CH group, and the difference was statistically significant (P0.05). The incidence of POCD may be correlated with the concentration of serum S100 尾 protein (r = 0.9927, P < 0.001 3). Conclusion: remifentanil CH can reduce blood loss, but increase the concentration of serum S100 尾 protein and increase the incidence of early postoperative POCD.
【作者单位】：榆林市第一医院麻醉科;
【基金】：榆林市科技计划项目(No.2014jh-20)
【分类号】：R614.2

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