不同每搏量变异度指导下的目标导向液体治疗对老年患者术后认知功能的影响

目的探讨每搏量变异度(stroke volume variation,SVV)指导的目标导向液体治疗对单膝关节置换术老年患者术后认知功能的影响。方法择期单膝关节置换术老年患者100例,随机均分为A组和B组。A组维持术中SVV 4%~9%,B组维持术中SVV 10%~14%。记录患者术中及术后24h液体出入量,术前及术后第1、3、5天C反应蛋白(C reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6),记录患者松止血带相关低血压和术前、术后第5天POCD的发生情况。结果两组患者性别、年龄等一般情况差异无统计学意义;与B组比较,A组术中输液量及术后24h尿量明显增加(P0.05);与术前比较,两组患者术后炎性因子含量均明显升高(P0.05);B组术后CRP和IL-6明显高于A组(P0.05)。A组因松止血带相关低血压发生率为22例(44%),明显低于B组的43例(86%)(P0.05)。POCD的发生率A组为11例(22.0%),B组为5例(10.0%),差异无统计学意义。结论 SVV指导术中液体治疗可以降低老年单膝关节置换术患者松止血带相关的低血压发生率以及围术期炎性反应。

Effects of goal-directed fluid therapy on postoperative cognitive function in elderly patients

Objective To investigate the influence of stroke volume variation (SVV)-guided fluid therapy on postoperative cognitive function in elderly patients undergoing the unilateral total knee arthroplasty(UTKA).Methods One hundred patients undergoing the UTKA were randomly di-vided into two groups,group A(SVV 4%-9%)and group B(SVV 10%-14%).The liquid manage-ment,serum markers (CRP,IL-6)and the incidences of deflating-tourniquet-related hypotension and preoperative, 5 d after surgery of the occurrence of POCD in two groups were recorded. Results There was no significant difference in general information between the two groups. Compared with group B,group A needed more fluid transfusion and had a higher 24 h urine volume. The CRP and IL-6 was significantly higher in group B than that in group A;The incidence of defla-ting-tourniquet-related hypotension in group A 22(44%)]was also lower than that in group B 43 (86%)].However,there was no significant difference in the incidence of POCD between the two groups.Conclusion Sufficient blood volume can help to reduce the incidence of deflating-tourniquet-related hypotension,and reduce the inflammatory reaction in elderly patients.