改良围术期GDFT用于高龄骨科患者术后早期认知障碍的预防

Improved perioperative goal-directed fluid therapy for the prevention of early postoperative cognitive impairment in elderly orthopaedic patients

目的观察改良围术期目标导向液体疗法用于高龄骨科患者术后早期认知障碍的预防作用。方法择期手术ASAⅠ~Ⅱ级75岁以上高龄病人60例随机分成两组,每组各30例,A组(对照组)术中按围术期目标导向液体疗法(GDFT)予以输液治疗;B组(实验组)术中予以改良围术期目标导向液体疗法,即在疗法开始时就经中心静脉泵注垂体后叶素0.0004μ/kg/min^0.0015μ/kg/min并随血压调整剂量。观察并记录患者术前1 d,术后1 d,4 d,7 d的简易智能状态量表(MMSE)评分和术后认知障碍(POCD)发生例数。结果术前1 d的两组MMSE评分比较无差异(P>0.05);术后1 d,4 d,7 d的B组MMSE评分高于A组(P<0.05)。POCD发生例数(%),术后1 d,4 d,7 d,B组少于A组(P<0.05)。结论改良围术期目标导向液体疗法用于高龄骨科患者术后早期认知障碍有显著预防作用。

Objective To observe improved perioperative goal-directed fluid therapy for the prevention of early postoperative cognitive impairment in elderly orthopaedic patients. Methods To select 60 cases elderly patients those who elder than 75 years and ASA physical status range from I to III,and randomly divided them into two groups. Group A（ control group） received perioperative goal-directed therapy（ GDFT） liquid transfusion treatment,while Group B（ experimental group） received improved perioperative goal-directed fluid therapy that central venous pump injection pituitrin 0.0004 u / kg / min-0.0015 u / kg / min at the beginning of therapy and adjust dosage with blood pressure. To observe and record the Minimental state examination（ MMSE） score of patients in 1 d,4d and 7d postoperative and the number of postoperative cognitive dysfunction（ POCD）. Results The comparison of MMSE score of 1d preoperative without difference between the two groups（ P〉0.05）. The MMSE scores of B group at 1d,4d and 7d postoperative were higher than group A（ P〈0. 05）. The number of postoperative cognitive dysfunction（ %） in group B were less than the group A（ P〈0. 05）. Conclusions The improved perioperative goal-directed fluid therapy has significant preventive action in early postoperative cognitive dysfunction for elder patient with orthopaedics.