急性等容血液稀释对老年患者全髋关节置换术后谵妄和炎症水平的影响

Effect of acute normovolemic hemodilution on postoperative delirium and inflammation in elderly patients undergoing total hip arthroplasty

目的探讨急性等容血液稀释(ANH)对老年患者全髋关节置换术后谵妄(POD)和炎症水平的影响。方法选择2020年4—8月择期拟行全髋关节置换术的老年患者80例,男47例,女33例,年龄65~80岁,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:ANH组(A组)和对照组(C组),每组40例。术前1 d采用简易智力状态检查(MMSE)量表进行基础认知评估。记录手术时间、液体出入量以及丙泊酚、舒芬太尼、瑞芬太尼用量。术后1~3 d采用意识模糊评估法(CAM)评估POD,并采用ELISA法测定白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α和C-反应蛋白(CRP)浓度。结果两组术前1 d MMSE评分、术中失血量、丙泊酚、舒芬太尼、瑞芬太尼用量差异无统计学意义。A组总补液量和尿量明显多于C组(P<0.05)。A组红细胞悬液输注率明显低于C组,输注量明显少于C组(P<0.05)。POD发生率明显低于C组(P<0.05)。术后1、2 d A组IL-6、TNF-α和CRP浓度明显低于C组(P<0.05)。结论急性等容血液稀释在老年全髋关节置换患者中的应用,在一定程度上减少了异体血的输注,降低炎性因子水平,减少术后谵妄的发生。

Objective To evaluate the effect of acute normovolemic hemodilution(ANH)on postoperative delirium(POD)and inflammation in elderly patients undergoing total hip arthroplasty.Methods Eighty patients underwent total hip arthroplasty from April 2020 to June 2020,47 males and 33 females,aged 65-80 years,ASA physical statusⅠorⅡ,were randomly divided into two groups:ANH group(group A)and control group(group C),40 patients in each group.All patients were assessed with mini-mental statement examination(MMSE)before operation.The operation time,the liquid of quantity,and the total consumption of propofol,sufentanil,and remifentanil were recorded.The patients were assessed with confusion assessment method(CAM)to determine whether they had delirium on the first,second and third day after operation.Blood samples were taken before operation,the first,second and third day after operation,and interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)levels were measured by enzyme-linked immunosorbent assay(ELISA).Results The differences of the MMSE score,intraoperative blood loss,consumption of propofol,sufentanil and remifentanil between the two groups had no statistical significance.The intravenous fluids and urine output in group A were significantly higher than those in group C(P<0.05).The blood transfusion of red blood cells and the volume in group A were significantly lower than that in group C(P<0.05).The increase of IL-6,TNF-αand CRP in group A was significantly lower than that in group C 1 day and 2 days after operation,and the incidence of POD in group A was significantly lower than that in group C(P<0.05).Conclusion The application of ANH in elderly patients undergoing total hip arthroplasty can reduce the transfusion of allogeneic blood to a certain extent,the level of inflammatory factors and the incidence of POD.