目标导向液体管理对老年患者脊柱融合术后认知及机体功能的影响

发布时间：2019-04-24 18:21

【摘要】：目的观察目标导向液体治疗(GDFT)对老年患者脊柱椎间融合内固定术后认知及机体功能的影响。方法 80例老年退行性腰椎管狭窄(DLSS)患者随机分为A、B两组,每组40例。A组根据患者术中平均动脉压、心率和中心静脉压等行常规液体治疗,B组在Flotrac/Vigileo监护仪监测每搏变异度(SVV)以及心指数(CI)下行GDFT。分别于手术开始前(T0)、手术完毕后(T1)以及术后第24 h(T2)3个不同时段采集乳酸(Lac)、尿素氮(BUN)等数据。通过分析术前1 d、术后6 h、24 h、3 d的简易精神状态量表(MMSE)评分分析认知功能障碍(POCD)发生率。结果两组患者术中失血量、回输例数及平均血液回输量比较无统计学差异(P0.05),B组输液量少于A组,A组尿量排出高于B组(P0.05)。A组与B组Lac、BUN水平在T0、T1、T3时点比较无统计学差异(P0.05)。A、B两组患者在手术后24 h、3 d时POCD发生率有统计学差异(P0.05)。结论老年患者在SVV/CI指导下行液体治疗,在减少输液量的同时能维持微循环灌注,不增加肾功能损害的风险,可有效优化术中体液管理,降低患者术后短期POCD的发生率。
[Abstract]:Objective to observe the effect of target-directed liquid therapy (GDFT) on cognition and body function after spinal fusion and internal fixation in elderly patients. Methods 80 elderly patients with degenerative lumbar spinal stenosis (DLSS) were randomly divided into two groups: group A (n = 40) and group B (n = 40). According to the mean arterial pressure (map), heart rate (HR) and central venous pressure (CPP), the patients in group A received routine liquid therapy. In group B, GDFT. was monitored with Flotrac/Vigileo monitor for stroke (SVV) and cardiac index (CI). The data of lactic acid (Lac), urea nitrogen (BUN) were collected before operation (T _ 0), after operation (T _ 1) and 24 hours after operation (T _ 2). The incidence of cognitive dysfunction (POCD) was analyzed 1 day before operation, 6 hours, 24 hours and 3 days after operation with the simplified Mental State scale (MMSE). Results there was no significant difference in blood loss, number of cases and average blood transfusion between the two groups (P0.05), B group was less than A group, urine output was higher in A group than in B group (P 0.05). A group and B group Lac,BUN level was T0, P 0.05, P < 0.05), and there was no significant difference between group A and group B (P 0.05, P < 0.05). There was no statistical difference in T _ 1 and T _ 3 time points (P0.05). There was significant difference in the incidence of POCD between group A and B at 24 hours and 3 days after operation (P0.05). Conclusion fluid therapy under the guidance of SVV/CI can not only reduce the volume of infusion but also maintain microcirculation perfusion without increasing the risk of impairment of renal function. It can effectively optimize intraoperative humoral management and reduce the incidence of short-term POCD after operation.
【作者单位】：邢台市人民医院麻醉科;邢台市人民医院手术室;
【分类号】：R614.2

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