目标导向液体治疗用于老年下肢骨折内固定术对平均动脉压变异率及N-端脑利钠肽前体的影响

Effect of target-directed fluid therapy on mean arterial pressure variability and N-end brain natriuretic peptide precursor in elderly patients with lower extremity fractures treated by internal fixation

目的探究目标导向液体治疗用于老年下肢骨折内固定术对平均动脉压(MAP)变异率及N-端脑利钠肽前体(NT-proBNP)的影响。方法选取2019年3月至2020年4月就诊威海市文登整骨医院的80例老年下肢骨折内固定术患者,采用随机数字表法分为对照组及观察组,各40例。对照组男22例,女18例,年龄(72.25±5.46)岁。观察组男23例,女17例,年龄(72.38±5.39)岁。对照组采用常规液体治疗,观察组采用目标导向液体治疗,比较两组患者补液量和麻醉前(T0)、麻醉后30 min(T1)、手术结束(T2)、术后2 h(T3)、术后6 h(T4)MAP变异率及NT-proBNP水平。结果观察组患者补液量(1.29±0.51)L,显著低于对照组(P<0.05);两组T0、T1时MAP水平比较,差异无统计学意义(P>0.05);T2时,观察组MAP(78.39±7.28)mmHg(1 mmHg=0.133 kPa),低于对照组(P<0.05);T3、T4时,观察组MAP(85.59±7.53)mmHg、(88.16±5.16)mmHg,高于对照组(均P<0.05)。观察组不同时间点△MAP水平分别为(17.95±2.46)mmHg、(1.63±1.47)mmHg、(3.90±0.56)mmHg、(1.33±0.36)mmHg,均显著低于对照组同期(均P<0.05);两组T0、T4时NT-proBNP水平差异无统计学意义(均P>0.05);观察组T1、T2、T3时NT-proBNP水平(385.26±42.37)ng/L、(301.25±58.79)ng/L、(270.12±39.47)ng/L,均显著低于对照组同期(均P<0.05)。结论目标导向液体治疗适用于老年下肢骨折内固定术患者,能够为患者术中提供更为稳定的MAP水平,降低NT-proBNP水平升高幅度,降低患者围术期心血管事件风险。

Objective To explore the effect of target-oriented fluid therapy on mean arterial pressure(MAP)variation and N-end brain natriuretic peptide precursor(NT-proBNP)in elderly patients with lower extremity fractures treated by internal fixation.Methods Eighty elderly patients taking internal fixation for lower extremity fractures at Wendeng Osteopathic Hospital from March 2019 to April 2020 were selected,and were divided into a control group and an observation group by the random number table method,with 40 cases in each group.There were 22 males and 18 females in the control group;they were(72.25±5.46)years old.There were 23 males and 17 females in the observation group;they were(72.38±5.39)years old.The control group took conventional fluid therapy,and the observation group target-oriented fluid therapy.The fluid supplement volumes and variation rates of MAP and NT-proBNP levels before(T0)and 30 min after(T1)anesthesia,at the end of the operation(T2),and 2 h(T3)and 6 h(T4)after the operation were compared between the two groups.Results The fluid supplement volume was(1.29±0.51)L in the observation group,which was lower than that in the control group(P<0.05).There were no statistical differences in the MAP's at T0 and T1 between these two groups(both P>0.05).At T2,the MAP was(78.39±7.28)mmHg(1 mmHg=0.133 kPa)in the observation group,which was lower than that in the control group(P<0.05).The MAP's at T3 and T4 were(85.59±7.53)mmHg and(88.16±5.16)mmHg in the observation group,which were higher than those in the control group(both P<0.05).The△MAP's at different time points were(17.95±2.46)mmHg,(1.63±1.47)mmHg,(3.90±0.56)mmHg,and(1.33±0.36)mmHg in the observation group,which were significantly lower than those in the control group(all P<0.05).There were no statistical differences in the NT-proBNP level at T0 and T4 between these two groups(both P>0.05).The NT-proBNP levels at T1,T2,and T3 were(385.26±42.37)ng/L,(301.25±58.79)ng/L,and(270.12±39.47)ng/L in the observation group,which were lower than those in the control group(all P<0.05).Conclusions Target-oriented fluid therapy is suitable for elderly patients taking internal fixation for lower extremity fractures.It can provide more stable MAP,and reduce the increase of NT-proBNP level and the risk of perioperative cardiovascular events.