CAJ | 학술논문

目的观察硫酸镁行控制性降压对髋关节置换术后的老年患者认知功能和脑氧代谢的影响.方法行髋关节置换术的老年患者60例,随机分为观察组(A组)和对照组(B组).A组手术开始后,泵注硫酸镁行控制性降压,平均动脉压(MAP)下降幅度在30％左右,保证MAP不低于60 mm Hg,术毕停止降压.B组不行控制性降压.两组于术前1d、术后4d测定简易智力状态检查表(MMSE)评分,分别于麻醉诱导前15 min(T0)、降压后15 min (T1)和术后15 min(T2)进行血气分析,计算动脉血氧含量(CaO2)、颈内静脉球部血氧含量(CjvO2)、动脉-颈内静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2).结果两组共有9例术后4d发生术后认知功能障碍(POCD),其中A组5例(16.7％),B组4例(13.3％).A组在降压15 min后Da-jvO2和CERO2轻度增加但仍在正常范围之内.两组患者各时点CaO2、CjvO2、Da-jvO2和CERO2组内、组间比较差异无统计学意义.结论硫酸镁行控制性降压不增加老年患者髋关节置换术后POCD的发生率.
목적 관찰류산미행공제성강압대관관절치환술후적노년환자인지공능화뇌양대사적영향.방법 행관관절치환술적노년환자60례,수궤분위관찰조(A조)화대조조(B조).A조수술개시후,빙주류산미행공제성강압,평균동맥압(MAP)하강폭도재30％좌우,보증MAP불저우60 mm Hg,술필정지강압.B조불행공제성강압.량조우술전1d、술후4d측정간역지력상태검사표(MMSE)평분,분별우마취유도전15 min(T0)、강압후15 min (T1)화술후15 min(T2)진행혈기분석,계산동맥혈양함량(CaO2)、경내정맥구부혈양함량(CjvO2)、동맥-경내정맥혈양함량차(Da-jvO2)화뇌양섭취솔(CERO2).결과 량조공유9례술후4d발생술후인지공능장애(POCD),기중A조5례(16.7％),B조4례(13.3％).A조재강압15 min후Da-jvO2화CERO2경도증가단잉재정상범위지내.량조환자각시점CaO2、CjvO2、Da-jvO2화CERO2조내、조간비교차이무통계학의의.결론 류산미행공제성강압불증가노년환자관관절치환술후POCD적발생솔.
Objective To investigated the effects of controlled hypotension on postoperative cognitive dysfunction (POCD) and cerebral oxygen metabolism in elderly patients undergoing hip-replacement.Methods Sixty elderly patients undergoing selective hip-replacement were enrolled in the study.The patients were randomized into two groups with 20 cases in each group.Magnesium sulfate was only administered in group A.Mean arterial pressure (MAP) was reduced by about 30％ and maintained at this level for 30 min.Blood gas analysis was carried out by taking blood samples from right internal jugular vein bulb and radial artery,and arterial to jugular bulb venous oxygen content difference (Da-jvO2) and cerebral oxygen extraction rate (CERO2) were calculated before,during and after controlled hypotension.MMSE was recorded 1 day before and 4 days after operation.Results Compared with group C,MMSE of group A showed no significant change (P ＜ 0.05).The values of Da-jvO2 and CERO2 increased in group A,showing no statistical significant difference.Conclusion Magnesium sulfate induced controlled hypotension in elderly patients undergoing hip-replacement had no effect on POCD.