静脉快通道麻醉联合综合保温对老年脊柱手术患者内稳态及术后认知功能的影响

Intravenous fast-tracking anesthesia combined with composite thermal insulation on internal environment homeostasis and postoperative cognitive dysfunction in elderly patients undergoing spinal surgery

目的:探讨静脉快通道麻醉联合综合保温对老年脊柱手术患者内稳态及术后认知功能的影响。方法:选择60例拟行腰椎手术的老年患者,ASAⅠ~Ⅱ级,随机分为静脉快通道麻醉联合常规保温组(R组)及静脉快通道麻醉联合综合保温组(T组),各30例。不同时间点监测并记录两组患者鼻咽温度,采集桡动脉血测定血气并行MMSE评分。结果:两组在麻醉诱导后各时间点血糖和血乳酸含量均较麻醉前升高(P<0.05),R组明显高于T组(P<0.05)。两组在麻醉后各时间点BE值均降低,T组术后1d时显著低于麻醉前(P<0.05),R组麻醉后120min、术毕及术后1d显著低于麻醉前和T组(P<0.05)。两组术后1dMMSE评分均显著低于术前1d(P<0.01),术后7d显著高于术后1d(P<0.05),仍低于术前1d,组间比较无显著差异(P>0.05)。结论:静脉快通道麻醉联合综合保温用于老年患者脊柱手术,对内环境稳态干扰小,降低术后认知功能障碍的风险,利于患者康复。

Objective:To investigate the impact of intravenous fast-tracking anesthesia combined with composite thermal insulation on internal environment homeostasis and postoperative cognitive dysfunction(POCD)in elderly patients undergoing spinal surgery.Methods:Sixty ASA I-II elderly patients undergoing elective spinal surgery were randomly divided into two groups:intravenous fast-tracking anesthesia combined with conventional thermal insulation(R group),intravenous fast-tracking anesthesia combined with composite thermal insulation(T group),30 cases in each group.We recorded the nasopharyngeal temperatures,and measured the changs of blood gas in different time points of radial artery blood.The results were scored with MMSE.Results:The blood glucose and lactate content were higher at different time points after anesthesia,and group R were significantly increased than that in group T(P<0.05).BE values were lower in two groups at different time points after anesthesia induction than those before anesthesia,and it was significantly reduced at the first day postoperative than that before anesthesia in group T(P<0.05).In group R,BE values was significantly reduced at 120 min after induction,and at the end of operation and at the first day postoperative than that before anesthesia and those in group T(P<0.05).In two groups,the MMSE score was decreased at the first day postoperative than that one day before operation,and it was significantly higher at the 7th day postoperative than that 1dafter operation(P<0.05).However,the results were still lower than that one day before operation,and the comparison between groups was not statistically significant(P >0.05).Conclusion:Intravenous fast-tracking anesthesia combined with composite thermal insulation on homeostasis in elderly patients undergoing spinal surgery can reduce the impact on patient's internal environment,reduce the risk of postoperative cognitive dysfunction and facilitate their postoperative recovery.