中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
7期
1000-1002
,共3页
脊柱手术%血液稀释%降压,控制性%认知功能
脊柱手術%血液稀釋%降壓,控製性%認知功能
척주수술%혈액희석%강압,공제성%인지공능
Spinal surgery%Hemodilution%Hypotention,controlled%Cognitive function
目的 观察急性高容血液稀释(AHH)联合控制性降压(CH)用于老年脊柱手术患者对其术后认知功能的影响,以评估该血液保护策略应用于老年人的安全性.方法 选择2010年9月至2012年3月潍坊市益都中心医院择期脊柱手术的老年患者60例,采用随机数字表法分为联合组和对照组,每组30例.对照组给予常规麻醉,联合组在常规麻醉基础上,给予6％羟乙基淀粉130/0.4氯化钠注射液联合盐酸尼卡地平注射液静脉滴注.分别于术前1d和术后4d评定患者的认知功能,比较2组患者术后认知功能障碍(POCD)的发生率.结果 2组术后4d视觉再认、符号测验评分均高于本组术前1d,差异有统计学意义[联合组视觉再认:(15.9±3.5)分比(13.3±2.4)分,对照组视觉再认:(16.1±3.4)分比(12.0±2.7)分;联合组符号测验:(14.7±1.4)分比(12.8±1.7)分,对照组符号测验:(15.8±2.2)分比(12.5±2.0)分,均P＜0.05],联合组术后4d联想学习评分低于对照组,组间差异有统计学意义[(10.9±2.2)分比(13.5±2.6)分,P＜0.05].余认知功能项目评分术前术后及组间差异均无统计学意义(P＞0.05).2组POCD发生率差异无统计学意义(P＞0.05).结论 按照本研究AHH的水平及CH的标准和时限,在有效保护血液的同时并未增加POCD的发生率.
目的 觀察急性高容血液稀釋(AHH)聯閤控製性降壓(CH)用于老年脊柱手術患者對其術後認知功能的影響,以評估該血液保護策略應用于老年人的安全性.方法 選擇2010年9月至2012年3月濰坊市益都中心醫院擇期脊柱手術的老年患者60例,採用隨機數字錶法分為聯閤組和對照組,每組30例.對照組給予常規痳醉,聯閤組在常規痳醉基礎上,給予6％羥乙基澱粉130/0.4氯化鈉註射液聯閤鹽痠尼卡地平註射液靜脈滴註.分彆于術前1d和術後4d評定患者的認知功能,比較2組患者術後認知功能障礙(POCD)的髮生率.結果 2組術後4d視覺再認、符號測驗評分均高于本組術前1d,差異有統計學意義[聯閤組視覺再認:(15.9±3.5)分比(13.3±2.4)分,對照組視覺再認:(16.1±3.4)分比(12.0±2.7)分;聯閤組符號測驗:(14.7±1.4)分比(12.8±1.7)分,對照組符號測驗:(15.8±2.2)分比(12.5±2.0)分,均P＜0.05],聯閤組術後4d聯想學習評分低于對照組,組間差異有統計學意義[(10.9±2.2)分比(13.5±2.6)分,P＜0.05].餘認知功能項目評分術前術後及組間差異均無統計學意義(P＞0.05).2組POCD髮生率差異無統計學意義(P＞0.05).結論 按照本研究AHH的水平及CH的標準和時限,在有效保護血液的同時併未增加POCD的髮生率.
목적 관찰급성고용혈액희석(AHH)연합공제성강압(CH)용우노년척주수술환자대기술후인지공능적영향,이평고해혈액보호책략응용우노년인적안전성.방법 선택2010년9월지2012년3월유방시익도중심의원택기척주수술적노년환자60례,채용수궤수자표법분위연합조화대조조,매조30례.대조조급여상규마취,연합조재상규마취기출상,급여6％간을기정분130/0.4록화납주사액연합염산니잡지평주사액정맥적주.분별우술전1d화술후4d평정환자적인지공능,비교2조환자술후인지공능장애(POCD)적발생솔.결과 2조술후4d시각재인、부호측험평분균고우본조술전1d,차이유통계학의의[연합조시각재인:(15.9±3.5)분비(13.3±2.4)분,대조조시각재인:(16.1±3.4)분비(12.0±2.7)분;연합조부호측험:(14.7±1.4)분비(12.8±1.7)분,대조조부호측험:(15.8±2.2)분비(12.5±2.0)분,균P＜0.05],연합조술후4d련상학습평분저우대조조,조간차이유통계학의의[(10.9±2.2)분비(13.5±2.6)분,P＜0.05].여인지공능항목평분술전술후급조간차이균무통계학의의(P＞0.05).2조POCD발생솔차이무통계학의의(P＞0.05).결론 안조본연구AHH적수평급CH적표준화시한,재유효보호혈액적동시병미증가POCD적발생솔.
Objective To investigate the effects of acute hypervolemic hemodilution(AHH) combined with controlled hypotension (CH) on postoperative cognitive function in elderly patients receiving spinal surgery.Methods Sixty cases of spinal surgery in elderly patients from September 2010 to March 2012 were randomly divided into 2 groups(n =30).All the patients in group H had mild AHH with 15 ml/kg 6％ hydroxyethyl starch.At the same time nicardipine was infused and the mean arterial pressure (MAP) was maintained at 70％ of the baseline.All patients in group C were as a control group.A set of six neuropsychological tests from the Wechsler Adult Intelligence Scale was administered on two occasions:1st day before operation and 4th day after operation.Results Four days visual recognition was performed in the two groups.The score and the sign test score were statistically higher than those before operation [visual recognition was performed again for the group H:with score (15.9 ± 3.5) vs (13.3 ± 2.4),and visual recognition was performed again for group C:with score (16.1 ± 3.4)vs (12.0 ± 2.7) ; sign test was performed for the group H:with score (14.7 ± 1.4) vs (12.8 ± 1.7),and sign test was performed for the group C:with score (15.8 ± 2.2) vs (12.5 ± 2.0),both of which P ＜ 0.05].Differences of scores before and after operation between groups had no statistical significance (P ＞ 0.05).Conclusion According to the criteria and time limit of CH and the level of AHH,AHH combined with CH can effectively protect the blood without increasing the incidence of POCD.
