控制性低中心静脉压对肝切除老年患者术后早期认知功能的影响

Effect of Controlled Low Central Venous Pressure on Early Postoperative Cognitive Function in Elderly Patients Undergoing Hepatic Resection

【目的】探讨控制性低中心静脉压（LCVP）对肝切除老年患者术后早期认知功能的影响。【方法】65岁以上AsAⅠ～Ⅱ级全麻下择期行肝切除术患者60例，随机分为LCVP组（L组）和对照组（C组），每组30例。L组患者在肝切除期间将中心静脉压（CVP）控制在2～5cmH2O，C组CVP维持在6～12cmH2O。所有患者均于术前1d和术后7d分别行神经心理学测试，即选用韦氏成人记忆、智力量表中的敏感项目和联线、钉板项目进行神经心理评估，再将各测试项目的术后值与术前值之差除以该测试项目健康对照组基准值（第一次测试结果）的标准差，即为该单项的Z分值，各单项Z分值相加得到复合Z分，两项单项Z分值或复合Z分≥1．96则判定为术后认知功能障碍。【结果】L组和C组患者术后7d认知功能障碍的发生率分别为23．33％和26．67％，两组比较没有显著性差异（P〉0．05）。【结论】控制性低中心静脉压对肝切除老年患者术后早期认知功能障碍的发生率无显著影响。

[Objective] To explore the effect of controlled low central venous pressure（LCVP） on early postoperative cognitive function in elderly patients undergoing hepatic resection. [Methods]Sixty ASA Ⅰ～Ⅱ patients（aged over 65 years old） scheduled for hepatic resection under general anesthesia were randomized into LCVP group（L group, n =30） and control group （C group, n =30）. In group L, central venous pressure （CVP） was maintained at 2- 5cmH2O during hepatectomy, while CVP in group C was maintained at 6 12cmH2O. All patients accepted neuropsychological test in a day before and 7 days after surgery. Sensitive i- tems from Wechsler Adult Memory Scale and Wechsler Adult Intelligence Scale, trail making test and the grooved pegboard test were used for neuropsychological evaluation. The value that the difference between the postoperative value and preoperative value of test items was divided the baseline value of healthy controls（the first test result） was the standard deviation（Z score）. The composite Z scores were the value that Z scores of each item were added up. When Z scores of two items or composite Z scores were 1.96 or more, the patients were diagnosed as postoperative cognitive dysfunction. [Results] The incidence of cognitive dysfunction 7 days after the operation in group L and group C were 23.33% and 26.67% respectively, but there was no signifi- cant difference between two groups （ P 〉0. 05）. [Conclusion] Controlled low central venous pressure has no significantly effect on the incidence of early postoperative cognitive dysfunction in elderly patients undergoing hepatic resection.