AHH联合CH对老年骨科手术患者术后MMSE评分及血清S-100β蛋白水平的影响
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摘要
目的:探讨急性高容量血液稀释(AHH)联合控制性降压(CH)对老年骨科手术患者术后简易智能精神状态检查量表(MMSE)评分及血清S~(-1)00β蛋白水平的影响。方法:将70例老年骨科择期手术患者随机分为观察组和对照组,每组35例。观察组应用6%羟乙基淀粉130/0.4行AHH,输注量为全身血容量的20%,同时静脉泵入硝普钠进行CH,速度为1μg·kg~(-1)·min~(-1),控制平均动脉压(MAP)在65~75mmHg。对照组不进行AHH和CH。记录2组患者术中出血量、异体输血量及尿量;观察2组患者术前、手术进行后1h、术毕及术后12h的MAP、心率(HR)、中心静脉压(CVP)等血流动力学指标;于术前、术后1d和术后3d对2组患者进行MMSE评分和血清S~(-1)00β蛋白含量测定。结果:(1)观察组术中失血量和异体血输注量明显少于对照组(P<0.05),尿量明显多于对照组(P<0.05)。(2)观察组术毕时MAP较术前降低(P<0.05),手术开始后1h时CVP较术前及对照组升高(P<0.05),但均在正常范围内。(3)与术前比较,2组术后1d的MMSE评分明显降低(P<0.05),术后3d有所恢复。2组术后1d和术后3d的S~(-1)00β蛋白水平较术前明显升高,但观察组升高幅度低于对照组(P<0.05)。结论:AHH联合CH可明显减少老年骨科手术患者的术中失血量和异体血输注量,降低术后认知功能障碍发生的风险。
Objective:To explore the influence of acute hypervolemic hemodilution(AHH)combined with controlled hypotension(CH)on mini-mental state examination(MMSE)score and serum level of S~(-1)00βprotein in elderly patients with orthopedic surgery.Method:A total of 70 cases of elderly patients with orthopedic surgery were divided randomly into observation group and control group,35 cases in each group.The patients in observation group were infused 6% hydroxyethyl starch 130/0.4,so that blood volume increased by about 20%,and CH was induced with sodium nitrate at a rate of 1μg/(kg·min),and to keep mean arterial pressure(MAP)at 65 to 75 mmHg.The patients in control group were not received AHH and CH.Intraoperative blood volume,allogeneic blood transfusion and urine volume were recorded in two groups.MAP,heart rate(HR)and central venous pressure(CVP)at preoperative,1 hafter surgery,end of operation and 12 hafter surgery were recorded in two groups.MMSE score and serum level of S~(-1)00βprotein at preoperative,1 dand 3 dafter surgery were determined in two groups.Result:(1)The blood loss and allogeneic blood transfusion in observation group were lower significantly than those in control group(P<0.05),and the urine volume was higher significantly than that in control group(P<0.05).(2)In observation group,MAP at end of operation was lower than that at preoperative(P<0.05),and CVP at 1 dafter surgery was higher than that at preoperative and in control group(P<0.05),but was in normal range.(3)Compared with that at preoperative,MMSE score at 1 dafter surgery was decreased significantly(P<0.05)in two groups,recovered at 3 dafter surgery.The serum levels of S~(-1)00βprotein at 1 dand 3 dafter surgery was higher significantly than that at preoperative in two groups,but the ascending range in observation group was lower than that in control group(P<0.05).Conclusion:AHH combined with CH can reduce significantly the intraoperative blood loss and blood transfusion in elderly patients with orthopaedic surgery,and reduce the risk of postoperative cognitive dysfunction.
Objective:To explore the influence of acute hypervolemic hemodilution(AHH)combined with controlled hypotension(CH)on mini-mental state examination(MMSE)score and serum level of S~(-1)00βprotein in elderly patients with orthopedic surgery.Method:A total of 70 cases of elderly patients with orthopedic surgery were divided randomly into observation group and control group,35 cases in each group.The patients in observation group were infused 6% hydroxyethyl starch 130/0.4,so that blood volume increased by about 20%,and CH was induced with sodium nitrate at a rate of 1μg/(kg·min),and to keep mean arterial pressure(MAP)at 65 to 75 mmHg.The patients in control group were not received AHH and CH.Intraoperative blood volume,allogeneic blood transfusion and urine volume were recorded in two groups.MAP,heart rate(HR)and central venous pressure(CVP)at preoperative,1 hafter surgery,end of operation and 12 hafter surgery were recorded in two groups.MMSE score and serum level of S~(-1)00βprotein at preoperative,1 dand 3 dafter surgery were determined in two groups.Result:(1)The blood loss and allogeneic blood transfusion in observation group were lower significantly than those in control group(P<0.05),and the urine volume was higher significantly than that in control group(P<0.05).(2)In observation group,MAP at end of operation was lower than that at preoperative(P<0.05),and CVP at 1 dafter surgery was higher than that at preoperative and in control group(P<0.05),but was in normal range.(3)Compared with that at preoperative,MMSE score at 1 dafter surgery was decreased significantly(P<0.05)in two groups,recovered at 3 dafter surgery.The serum levels of S~(-1)00βprotein at 1 dand 3 dafter surgery was higher significantly than that at preoperative in two groups,but the ascending range in observation group was lower than that in control group(P<0.05).Conclusion:AHH combined with CH can reduce significantly the intraoperative blood loss and blood transfusion in elderly patients with orthopaedic surgery,and reduce the risk of postoperative cognitive dysfunction.
引文
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[2]熊华平,吴志云,查本俊.急性高容量血液稀释联合控制性降压用于全髋关节置换术患者的临床观察[J].临床军医杂志,2015,43(11):843-847.
[3]魏淑明.急性高容性血液稀释对顺式阿曲库铵药效学的影响[J].泰山医学院学报,2012,33(1):34-37.
[4]钟锦秀,张培冰.急性高容性血液稀释联合控制性降压在人工全髋关节置换术中的应用[J].中国医药导刊,2015,17(6):602-604.
[5]孙丽娜,赵军舰,王玉虎.急性高容量血液稀释联合控制性降压对老年患者心肌钙蛋白Ⅰ的影响[J].武警医学,2012,23(3):203-206.
[6]Peng L,Xu L,Ouyang W.Role of peripheral inflammatory markers in postoperative cognitive dysfunction(POCD):a meta-analysis[J].PLoS One,2013,8:79624.
[7]梁华,丁志刚,刘晓华,等.急性高容量血液稀释联合控制性降压对老年脊柱手术患者内稳态及术后认知功能的影响[J].宁夏医科大学学报,2015,37(4):400-404.
[8]孙梅杰,边雯,李慧禄,等.瑞芬太尼控制性降压对老年患者鼻内镜术后认知功能和脑氧代谢的影响[J].中国老年学杂志,2014,37(9):2358-2360.
[9]Jin WJ,Feng SW,Feng Z,et al.Minocycline improves postoperative cognitive impairment in aged mice by inhibiting astrocytic activation[J].Neuroreport,2014,25:1-6.
[10]Donato R,Cannon BR,Sorci G,et al.Functions of S100proteins[J].Curr Mol Med,2013,13:24-57.