| 急性超容血液稀释对老年脊柱手术患者S-100β蛋白、NSE水平及POCD的影响 |
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投稿时间：2018-11-13
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| 作者 | Author | 单位 | Address | E-Mail |
| 徐培 |
XU Pei |
霸州市第二医院骨外科, 河北 霸州 065700 |
Department of Bone Surgery, the Second Hospital of Bazhou City, Bazhou 065700, Hebei, China |
qw6654359@163.com |
| 杨进 |
YANG Jin |
霸州市第二医院骨外科, 河北 霸州 065700 |
Department of Bone Surgery, the Second Hospital of Bazhou City, Bazhou 065700, Hebei, China |
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| 刘震 |
LIU Zhen |
霸州市第二医院骨外科, 河北 霸州 065700 |
Department of Bone Surgery, the Second Hospital of Bazhou City, Bazhou 065700, Hebei, China |
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| 齐巍 |
QI Wei |
霸州市第二医院骨外科, 河北 霸州 065700 |
Department of Bone Surgery, the Second Hospital of Bazhou City, Bazhou 065700, Hebei, China |
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| 齐凡 |
QI Fan |
霸州市第二医院骨外科, 河北 霸州 065700 |
Department of Bone Surgery, the Second Hospital of Bazhou City, Bazhou 065700, Hebei, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第10期，第923-927页 |
| DOI：10.3969/j.issn.1003-0034.2019.10.010 |
| 基金项目:廊坊市科学技术研究与发展计划（编号：2018013038） |
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中文摘要:
目的：探讨急性超容血液稀释（AHH）对老年脊柱手术患者S-100β蛋白、神经元特异性烯醇化酶（NSE）水平及术后认知功能障碍（POCD）的影响。
方法：选择择期骨科脊柱手术患者80例，ASA分级Ⅰ-Ⅱ级。按照随机数字表将患者分为AHH组和C组，每组40例。AHH组麻醉诱导后应用6%羟乙基淀粉130/0.4以20 ml/min速度行AHH，输注量为全身血容量的20%。C组不实施血液稀释，麻醉和手术方法与AHH组相同。记录两组术中出血量、异体输血量及尿量；于术前1 d、手术开始后1 h、术毕、术后12 h记录平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）；于术前1 d、手术开始后15 min、手术开始后45 min、术毕检测动脉血氧含量（CaO2）、静脉血氧含量（CjvO2）、动静脉血氧含量差（Da-jvO2）及脑氧摄取率（CERO2）；于术前1 d，术后1、3、7 d行简易智能精神状态检查量表（MMSE）评分和S-100β蛋白、NSE水平测定。记录两组POCD发生率。
结果：（1）AHH组术中出血量、输异体血量少于C组（P<0.05），尿量多于C组（P<0.05）。（2）与术前1 d及C组同时间点比较，AHH组术毕时MAP［（75.6±4.1）mmHg］降低（P<0.05）；与术前1 d及C组同时间点比较，AHH组手术开始后1 h时CVP［（6.9±0.6）cmH2O］升高（P<0.05），但均在正常范围内。（3）与术前1 d及C组同时间点比较，AHH组手术开始后15 min、45 min、术毕时Da-jvO2、CERO2水平下降（P<0.05）。（4）与术前1 d比较，两组术后1 d的MMSE评分下降（P<0.05），S-100β蛋白和NSE水平升高（P<0.05），术后3、7 d有所恢复。两组间术后1 d的MMSE评分、S-100β蛋白和NSE水平差异有统计学意义（P<0.05）。（5）两组POCD发生率差异无统计学意义（P>0.05）。
结论：AHH可明显减少老年脊柱手术患者的术中失血量和异体血输注量，降低S-100β蛋白和NSE水平，不增加POCD的发生风险。 |
| 【关键词】急性超容量血液稀释 S-100β蛋白 神经元特异性烯醇化酶 术后认知功能障碍 脊柱手术 老年人 |
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| Influences of acute hypervolemic hemodilution on serum levels of S-100β protein,NSE and POCD in elderly patients with spinal surgery |
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ABSTRACT
Objective:To explore the influences of acute hypervolemic hemodilution(AHH) on serum levels of S-100β protein,neuron specific enolase(NSE) and postoperative cognitive dysfunction POCD in elderly patients with spinal surgery.
Methods:A total of 80 cases elderly patients requiring elective spinal operation were divided into AHH group and C group according to random digits table,40 cases in each group,with ASA gradeⅠ-Ⅱ. The patients in AHH group were infused 6% hydroxyethyl starch 130/0.4 at a rate of 20 ml/min after anesthesia induction,and blood volume increased by about 20%,the patients in C group were not received AHH,anesthesia and surgical methods were the same as those in AHH group. Intraoperative blood volume,allogeneic blood transfusion and urine volume were recorded. Mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP) at preoperative 1 d,1 h after the start of surgery,end of operation,12 h after surgery were observed. Arterial blood oxygen content (CaO2),venous blood oxygen content (CjvO2),arteriovenous oxygen content difference (Da-jvO2),and cerebral oxygen uptake(CERO2) were measured at 1 d before surgery,15 min after surgery,45 min after surgery,end of surgery. Mini-mental state examination(MMSE) score and serum levels of S-100β protein,NSE were measured at 1 d before surgery,1,3,7 d after surgery. POCD rates of two groups were recorded.
Results:Intraoperative blood loss and allogeneic blood transfusion in AHH group was significantly lower than those in C group(P<0.05),and the urine volume was significantly higher than that in C group (P<0.05). Compared with preoperative 1 day,MAP was decreased and CVP was increased at end of surgery in AHH group,compared with C group at the same time,MAP was lower and CVP was higher in AHH group,but both were in normal range. Compared with preoperative 1 day and C group,the levels of Da-jvO2 and CERO2 in AHH group was decreased at 15,45 min after the start of the operation and end of surgery(P<0.05). Compared with preoperative 1 day,MMSE scores of two groups at 1 day after surgery was decreased (P<0.05),the levels of S-100β protein and NSE were increased(P<0.05),and restored at 3,7 days after surgery. There was statistical difference in MMSE scores,the levels of S-100β protein,NSE at 1 day after surgery between two groups (P<0.05). There was no statistical difference in POCD rate between two groups(P>0.05).
Conclusion:AHH can significantly reduce intraoperative blood loss and blood transfusion in elderly patients with spinal surgery,and decrease the levels of S-100β protein and NSE,does not increase the risk of the occurrence of POCD. |
| KEY WORDS Acute hypervolemic hemodilution S-100β protein Neuron specific enolase Postoperative cognitive dysfunction Spinal surgery Elderly |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 徐培,杨进,刘震,齐巍,齐凡.急性超容血液稀释对老年脊柱手术患者S-100β蛋白、NSE水平及POCD的影响[J].中国骨伤,2019,32(10):923~927 |
| 英文格式: | XU Pei,YANG Jin,LIU Zhen,QI Wei,QI Fan.Influences of acute hypervolemic hemodilution on serum levels of S-100β protein,NSE and POCD in elderly patients with spinal surgery[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(10):923~927 |
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