中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2013年
3期
296-299
,共4页
赵媛%张汉湘%孔高茵%何明艳%潘冰冰
趙媛%張漢湘%孔高茵%何明豔%潘冰冰
조원%장한상%공고인%하명염%반빙빙
肝切除术%降压,控制性%中心静脉压%老年人
肝切除術%降壓,控製性%中心靜脈壓%老年人
간절제술%강압,공제성%중심정맥압%노년인
Hepatectomy%Hypotension,controlled%Central venous pressure%Aged
目的 观察老年患者肝叶切除手术中使用控制性低中心静脉压技术(LCVP)后患者术后早期认知功能的改变,探讨LCVP用于老年患者的安全性和可行性.方法 择期行肝叶切除的闰国麻醉学会(ASA)分级Ⅰ～Ⅱ级老年患者45例,年龄60～75岁,分为实验组与对照组:实验组肝实质离断期间维持中心静脉压(CVP)在0～5 cmH2O,离断后使中心静脉压恢复到正常水平.对照组为正常输液组,维持中心静脉压6～ 12 cmH2O.比较两组术后麻醉苏醒恢复情况,术前1d及术后第7天采用一系列神经心理测试评估患者认知功能.结果 与对照组相比,切肝时实验组的平均动脉压(MAP)[(75.8 ±7.9) mmHg]和CVP[(3.1 ±0.4) cmH2O]均低于对照组[MAP(92.3±10.6) mmHg、CVP(9.3±1.4)cmH2O],差异有统计学意义(t'=20.08,P＜0.05,t=5.89,P＜0.01)；两组患者术后自主呼吸恢复时间、呼之睁眼时间、拔管时间和离开手术室时间比较差异无统计学意义[(18.1±6.7)min、(25.4 ±8.3)min、(31.9±11.7)min、(42.8±17.8)min vs(15.3 ±7.0)min、(22.6±9.4)min、(30.2±10.8)min、(45.4±13.6)min,P＞0.05],实验组的术后认识功能障碍(POCD)发生率为30.0％,对照组的为27.3％,两组比较差异无统计学意义(P＞0.05).结论 控制性低中心静脉压对老年肝叶切除术患者的麻醉苏醒时间和术后早期认知功能无明显影响.
目的 觀察老年患者肝葉切除手術中使用控製性低中心靜脈壓技術(LCVP)後患者術後早期認知功能的改變,探討LCVP用于老年患者的安全性和可行性.方法 擇期行肝葉切除的閏國痳醉學會(ASA)分級Ⅰ～Ⅱ級老年患者45例,年齡60～75歲,分為實驗組與對照組:實驗組肝實質離斷期間維持中心靜脈壓(CVP)在0～5 cmH2O,離斷後使中心靜脈壓恢複到正常水平.對照組為正常輸液組,維持中心靜脈壓6～ 12 cmH2O.比較兩組術後痳醉囌醒恢複情況,術前1d及術後第7天採用一繫列神經心理測試評估患者認知功能.結果 與對照組相比,切肝時實驗組的平均動脈壓(MAP)[(75.8 ±7.9) mmHg]和CVP[(3.1 ±0.4) cmH2O]均低于對照組[MAP(92.3±10.6) mmHg、CVP(9.3±1.4)cmH2O],差異有統計學意義(t'=20.08,P＜0.05,t=5.89,P＜0.01)；兩組患者術後自主呼吸恢複時間、呼之睜眼時間、拔管時間和離開手術室時間比較差異無統計學意義[(18.1±6.7)min、(25.4 ±8.3)min、(31.9±11.7)min、(42.8±17.8)min vs(15.3 ±7.0)min、(22.6±9.4)min、(30.2±10.8)min、(45.4±13.6)min,P＞0.05],實驗組的術後認識功能障礙(POCD)髮生率為30.0％,對照組的為27.3％,兩組比較差異無統計學意義(P＞0.05).結論 控製性低中心靜脈壓對老年肝葉切除術患者的痳醉囌醒時間和術後早期認知功能無明顯影響.
목적 관찰노년환자간협절제수술중사용공제성저중심정맥압기술(LCVP)후환자술후조기인지공능적개변,탐토LCVP용우노년환자적안전성화가행성.방법 택기행간협절제적윤국마취학회(ASA)분급Ⅰ～Ⅱ급노년환자45례,년령60～75세,분위실험조여대조조:실험조간실질리단기간유지중심정맥압(CVP)재0～5 cmH2O,리단후사중심정맥압회복도정상수평.대조조위정상수액조,유지중심정맥압6～ 12 cmH2O.비교량조술후마취소성회복정황,술전1d급술후제7천채용일계렬신경심리측시평고환자인지공능.결과 여대조조상비,절간시실험조적평균동맥압(MAP)[(75.8 ±7.9) mmHg]화CVP[(3.1 ±0.4) cmH2O]균저우대조조[MAP(92.3±10.6) mmHg、CVP(9.3±1.4)cmH2O],차이유통계학의의(t'=20.08,P＜0.05,t=5.89,P＜0.01)；량조환자술후자주호흡회복시간、호지정안시간、발관시간화리개수술실시간비교차이무통계학의의[(18.1±6.7)min、(25.4 ±8.3)min、(31.9±11.7)min、(42.8±17.8)min vs(15.3 ±7.0)min、(22.6±9.4)min、(30.2±10.8)min、(45.4±13.6)min,P＞0.05],실험조적술후인식공능장애(POCD)발생솔위30.0％,대조조적위27.3％,량조비교차이무통계학의의(P＞0.05).결론 공제성저중심정맥압대노년간협절제술환자적마취소성시간화술후조기인지공능무명현영향.
Objective To observe the change of early postoperative cognition in the elderly under low central venous pressure (LCVP) after lobe resection to investigate the safety and feasibility of LCVP in Geriatrics.Methods A total of 45 ASA class Ⅰ ～ Ⅱ old patients (60 ～ 75 y)with elective liver resection were divided into L group and C group.In the LCVP group (L group),CVP was maintained below 5 cmH2O during liver resection until the lobe was done.The patients in the control group (C group) received standard care (The CVP was controlled between 6 cmH2O to 12 cmH2O).To compare the anesthesia recovery after surgery,all patients were tested with a battery of neuropsychologic assessment of cognitive function preoperatively and on the 7th day postoperatively.Results During liver resection,the MAP [(75.8 ±7.9)mmHg] and CVP [(3.1 ±0.4)cmH2O] of experimental group were lower than the control group [MAP (92.3 ± 10.6)mmHg,CVP(9.3 ± 1.4)cmH2O].The difference was statistically significant (t' =20.08,P ＜0.05,t =5.89,P ＜0.01) ;There was no statistically significant difference in postoperative recovery of spontaneous breathing,respiratory,eye opening time,extubation time and leave the operating room time between two groups[(18.1 ±6.7)min,(25.4±8.3)min,(31.9±11.7)min,(42.8±17.8)minvs (15.3 ± 7.0)min,(22.6 ±9.4)min,(30.2 ± 10.8) min,(45.4 ± 13.6) min,P ＞ 0.05].The incidence of POCD was 30.0％ in the experimental group and 27.3％ in the control group.The difference was no statistical significance between two groups(P ＞0.05).Conclusious There was no significant influence of low central venous pressure on anesthesia recovery time and early postoperative cognition in the elderly under hepatic resections.
