不同血压调控水平对老年患者髋关节置换术中局部脑氧饱和度及术后谵妄的影响

Effects of different levels of intraoperative blood pressure regulation on cerebral oxygen saturation and postoperative delirium in elderly patients undergoing hip repalcement

目的探讨术中不同血压调控水平对老年患者髋关节置换术中局部脑氧饱和度(rSO2)及术后谵妄的影响。方法择期全麻下行髋关节置换术患者150例,男54例,女96例,年龄65~80岁,ASAⅡ或Ⅲ级,采用随机数字表法分为三组:A组术中MAP维持在基础值的80%~90%,B组MAP维持在基础值的90%~100%,C组MAP维持在基础值的100%~110%。记录术前(T0)、麻醉后5 min(T1)、手术开始后5 min(T2)、30 min(T3)、60 min(T4)、手术结束时(T5)、手术结束后5 min(T6)的MAP、HR和rSO2。记录术后3 d内谵妄发生情况以及PACU停留时间、住院时间和术后并发症等。结果与C组比较,T2-T6时A组和B组rSO2明显降低(P<0.05)。A组术后谵妄有10例(20%),B组有8例(16%),C组有1例(2%),A、B组发生率明显高于C组(P<0.05)。与C组比较,A、B组PACU停留时间及住院时间明显延长(P<0.05)。A、B组苏醒期躁动发生率明显高于C组(P<0.05)。结论MAP维持于基础值的100%~110%有助于降低术后谵妄及苏醒期躁动发生率,缩短住院时间,可能与术中局部脑氧饱和度升高有关。

Objective To evaluate the effect of different intraoperative blood pressure regulation on regional cerebral oxygen saturation(rSO2)and postoperative delirium in elderly patients undergoing hip replacement.Methods A total of 150 patients,54 males and 96 famales,aged 65-80 years,falling into ASA physical statusⅡorⅢ,scheduled for elective hip replacement under general anesthesia,were divided into three groups using a random number table:MAP was maintained at 80%-90%of the base value(group A),MAP was maintained at 90%-100%of the base value(group B),and MAP was maintained at 100%-110%of the base value(group C).MAP,HR and rSO2 were recorded before the induction of anesthesia(T0),5 min after induction of anesthesia(T1),5 min,30 min,60 min after incision(T2-T4),at the end of surgery(T5),and 5 min after surgery(T6).The length of PACU stay and hospital stay and postoperative complications were recorded.Results Compared with group C,bilateral rSO2 value decreased at T2-T6 in group A and group B(P<0.05).The incidence of postoperative delirium was 20%in group A,16%in group B,and 2%in group C.Compared with group C,the incidence of postoperative delirium were significantly increased in groups A and B(P<0.05),and the length of PACU stay and hospital stay were prolonged in group A and group B(P<0.05).The incidence of emergence agitation in groups A and B was significantly higher than in group C(P<0.05).Conclusion Intraoperative blood pressure maintained at 100%-110%of the base value,helps reduce the incidence of postoperative delirium and emergence agitation,shorten the length of PACU stay and hospital stay,which may be related to increased cerebral oxygen saturation during surgery.