| 急性超容血液稀释对老年脊柱手术患者S-100β蛋白、NSE水平及POCD的影响 |
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投稿时间：2018-08-09 修订日期：2018-09-30
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| 期刊信息：《中国骨伤》年，第卷，第期，第-页 |
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| 中文摘要:［］ 目的 探讨急性超容血液稀释(AHH)对老年脊柱手术患者S-100β蛋白、神经元特异性烯醇化酶(NSE)水平及术后认知功能障碍(POCD)的影响。方法 选择择期骨科脊柱手术患者80例,ASA分级Ｉ～Ⅱ级。按照入院顺序将患者随机分为AHH组和C组,每组40例。AHH组麻醉诱导后应用 6%羟乙基淀粉130/0.4 以20 mL/min 速度行AHH,输注量为全身血容量的20%。C组不实施血液稀释,麻醉和手术方法与AHH组相同。记录两组术中出血量、异体输血量及尿量；于术前1d、手术开始后1h、术毕、术后12h 记录平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)；于术前1d、手术开始后15min、手术开始后45min、术毕检测动脉血氧含量(CaO2)、静脉血氧含量(CjvO2)、动静脉血氧含量差(Da-jvO2)及脑氧摄取率(CERO2)；于术前1d、术后1d、3d、7d行简易智能精神状态检查量表(MMSE)S评分和S?100β蛋白、NSE血清水平测定。记录两组POCD发生率。结果 ①AHH组术中出血量、输异体血量少于C组(P＜0.05),尿量多于C组(P＜0.05)。②与术前1d比较,AHH组术毕时MAP降低(P＜0.05)；与术前1d及C组比较,手术开始后1h 时CVP升高(P＜0.05),但均在正常范围内。③与术前1d及C组比较,AHH组手术开始后15min、45min、术毕时Da-jvO2、CERO2水平下降(P＜0.05)。④与术前1d比较,两组术后1d 的MMSE 评分下降(P＜0.05),S-100β蛋白和NSE 水平升高(P＜0.05),术后3d、7d 有所恢复。两组间术后1d 的MMSE 评分、S-100β蛋白和NSE 水平有统计学差异(P＞0.05)。⑤两组 POCD发生率无统计学差异(P＞0.05)。结论 AHH可明显减少老年脊柱手术患者的术中失血量和异体血输注量,降低 S?100β蛋白和NSE水平,不增加POCD的发生风险。 |
| 【关键词】急性超容量血液稀释 S-100β蛋白 神经元特异性烯醇化酶 术后认知功能障碍 脊柱手术 老年患者 |
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| Influences of acute hypervolemic hemodilution on serum levels of S-100β protein, NSE and POCD in elderly patients with spinal surgery |
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| ABSTRACT Objective To explore the influences of acute hypervolemic hemodilution(AHH) on serum levels of s-100β protein, neuron specific enolase (NSE) and (postoperative cognitive dysfunction,POCD) in elderly patients with spinal surgery. Methods 80 cases of elderly patients with spinal surgery were divided randomly into AHH group and C group, 40 cases in each group. The patients in AHH group were infused 6％ hydroxyethyl starch 130/0.4 at a rate of 20 mL/min after anesthesia induction,and blood volume increased by about 20%, the patients in C group were not received AHH, anesthesia and surgical methods were the same as those in AHH group.Intraoperative blood volume, allogeneic blood transfusion and urine volume were recorded. Mean arterial pressure(MAP), heart rate(HR), central venous pressure(CVP) at preoperative 1d, 1h after surgery, end of operation, 12h after surgery were recorded.Arterial blood oxygen content (CaO2), venous blood oxygen content (CjvO2), arteriovenous oxygen content (Da-jvO2) and cerebral oxygen uptake (CERO2) were measured at 1d before surgery, 15min after surgery, 45min |
| KEY WORDS Acute hypervolemic hemodilution S-100β protein, Neuron specific enolase Postoperative cognitive dysfunction Spinal surgery Elderly patients |
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