目标导向液体治疗对老年全髋置换术患者脏器灌注能力的影响

Effect of Target-Oriented Fluid on the Perfusion Ability of Important Organs in Elderly Patients Undergoing Total Hip Replacement

目的探讨目标导向液体治疗对老年全髋置换术患者脏器灌注能力的影响。方法选择2020年2月—2022年7月淄博市骨科医院收治的需行全髋关节置换术患者40例,所有入组者均实施椎管内麻醉联合喉罩置入全身麻醉,测定每搏变异度(variation of stroke volume,SVV)指导液体治疗。比较干预前后患者脑氧分压和脑灌注压(cerebral perfusion pressure,CPP)变化情况;干预前后患者脑氧供需情况,干预前后患者血流动力学指标;干预前后患者神经烯醇化酶(serum neuron-specific enolase,NSE)及血乳酸水平变化情况;干预前后患者机体抗氧化能力,统计所有入组者围麻醉期并发症发生情况。结果干预后患者脑氧分压和CPP均高于干预前(P<0.05),动脉血氧含量(arterial oxygen content,CaO2)、静脉血氧含量(venous blood oxygen content,CjvO2)及脑氧摄取率(cerebral oxygen uptake rate,CERO2)均高于干预前(P<0.05);双侧大脑中动脉收缩峰血流速度(peak systolic blood flow velocity,Vs)、平均血流速度(average blood flow velocity,Vm)水平高于干预前(P<0.05);血管搏动指数(pulsatility index,PI)水平低于干预前(P<0.05),NSE和血乳酸水平均低于干预前(P<0.05);超氧化物歧化酶(superoxide superoxide dismutase,SOD)水平高于干预前(P<0.05);丙二醛(malondaldehyde,MDA)水平低于干预前(P<0.05)。所有入组者围麻醉期未见围手术期恶心呕吐、术后认知功能障碍、低血压、围手术期头晕躁动等并发症。结论针对老年全髋关节置换术患者,实施每搏量变异度指导下目标导向液体治疗,可更好地确保血流动力学稳定,提高组织灌注,减少中枢神经系统损伤,提高机体抗氧化能力,减少围手术期并发症。

Objective To explore the effect of target-oriented fluid on the perfusion ability of important organs in elderly patients undergoing total hip replacement.Methods A total of 40 patients who needed total hip arthroplasty in Zibo Orthopedic Hospital were selected from February 2020 to July 2022.All patients were given intraspinal anesthesia combined with laryngeal mask implantation general anesthesia.The variability of beats(SVV)was measured to guide fluid therapy.The changes of cerebral oxygen partial pressure and cerebral perfusion pressure(CPP)before and after intervention were compared.The cerebral oxygen supply and demand before and after intervention,the hemodynamic indexes before and after intervention,the changes of serum neuron-specific enolase(NSE)and blood lactate levels before and after intervention were compared.Results After intervention,the cerebral oxygen partial pressure and CPP of the patients were higher than before intervention(P<0.05),and the arterial oxygen content(CaO2),venous blood oxygen content(CjvO2),and cerebral oxygen uptake rate(CERO2)were all higher than before intervention(P<0.05),and systolic peak blood flow velocity(Vs)and mean blood flow velocity(Vm)of bilateral middle cerebral arteries were higher than those before intervention(P<0.05).The blood vessel pulsatility index(PI),NSE and blood lactate levels were lower than those before intervention(P<0.05).Superoxide dismutase(SOD)levels were higher than those before intervention(P<0.05).Malondialdehyde(MDA)levels were lower than those before intervention(P<0.05).Conclusion Target-directed fluid therapy under the guidance of stroke volume variability can better ensure hemodynamic stability,improve tissue perfusion,reduce central nervous system injury,improve antioxidant capacity and reduce perioperative complications.