[1]边步荣,高素琴,刘波,等.瑞芬太尼控制性降压对老年脊柱手术患者术后认知功能障碍的影响[J].中华老年骨科与康复电子杂志,2017,(06):336-340.[doi:10.3877/cma.j.issn.2096-0263.2017.06.004]
　Bian Burong,Gao Suqin,Liu Bo,et al.Effect of Remifentanil induced hypotension postoperative cognitive dysfunction obstruction in elderly patients undergoing spinal surgery[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(06):336-340.[doi:10.3877/cma.j.issn.2096-0263.2017.06.004]
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瑞芬太尼控制性降压对老年脊柱手术患者术后认知功能障碍的影响()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2017年06期
页码:
336-340
栏目:
出版日期:
2017-11-27

文章信息/Info

Title:
Effect of Remifentanil induced hypotension postoperative cognitive dysfunction obstruction in elderly patients undergoing spinal surgery
作者:
边步荣; 高素琴; 刘波; 高彦东; 张利佳; 郭宇峰
719000 榆林，延安大学医学院第二附属医院麻醉科
Author(s):
Bian Burong;  Gao Suqin;  Liu Bo;  Gao Yandong;  Zhang Lijia;  Guo Yufeng
Department of Anesthesiology, the Second Affiliated Hospital of Yan’an University, yulin 719000, China
关键词:
认知障碍;  麻醉; 全身;  低血压; 控制;  瑞芬太尼;  S100β蛋白
Keywords:
Cognitive disorders;  Anesthesia;  general;  Hypotension;  controlled;  Remifentanil;  S100β protein
DOI:
10.3877/cma.j.issn.2096-0263.2017.06.004
文献标志码:
A
摘要:
目的 观察瑞芬太尼控制性降压（CH）对老年脊柱手术患者术后认知功能障碍（POCD）和血清 S100β蛋白含量的影响。方法 前瞻性收集 2014年 1月至 2017年 05月延安大学医学院第二附属医院收治的符合纳入排除标准的脊柱手术患者 60例，随机分为 CH组（n=30）和非 CH组（n=30）。CH组通过调整瑞芬太尼泵注速率，使平均动脉压（MAP）降至基础值的 70%～80%，非 CH组维持基础血压。分别于麻醉诱导前、术后第 1、2、3、7天随访并比较两组患者的 POCD发生率、血清 S100β蛋白含量、术中失血量及麻醉时间。结果 两组患者术后第 1天 POCD发生率均为 25%以上，两组间比较差异无统计学意义（P＞0.05），术后第 2、3 天 CH 组 POCD 发生率高于非 CH 组，差异具有统计学意义（c2=4.320， c2 =4.043，P＜0.05），术后第 7天均降至 5%以下，两组间比较差异无统计学意义（P＞0.05）；两组患者术后第 1天血清 S100β蛋白含量高于麻醉前水平，差异具有统计学意义（CH组：F=4.621，非 CH组：F=4.233， P＜0.05），CH组术后第 2、3天血清 S100β蛋白水平高于非 CH组（F=8.202，F=7.625，P＜0.05）；CH组失血量少于非 CH 组（t=0.495，P＜0.05）；血清 S100β蛋白含量与 POCD 发生率密切相关（r=0.993， P＜0.05）。结论 瑞芬太尼 CH用于老年脊柱手术患者，可减少术中失血，但提高了血清 S100β蛋白含量，早期术后 POCD发生率较高。
Abstract:
Objective To observe the efficacy of remifentanil controlled- hypotension on postoperative cognitive dysfunction (POCD) and S100β protein in elderly patients underwent spinal surgery. Methods A prospective review was conducted in 60 elderly patients ubderwent spinal surgeries from January to December 2015, patients were divided into controlled-hypotension group (CH) and non-controlled hypotension group (NCH) randomly, 30 patients in each group. The mean arterial blood pressure in CH group were reduced to 70%-80% of the basic values of adjusted remifentanil infusion rate, and those in NCH group were maintained basal blood pressure. The incidence of POCD, serum S100β protein, intraoperative blood loss and anesthesia time were followed up and compared at pre-anesthesia induction and the 1, 2, 3, 7 day after surgery. Results The incidence of POCD in two groups at the first postoperative day was over 25% , and there was no significant difference between two groups (P>0.05). However, it was significant higher in the CH group than the NCH group at 2, 3 day after surgery (c2=4.320, c2=4.043, P<0.05). In postoperative 7 days, It was reduced to less than 5%, with no significant difference between two groups (P> 0.05). At 1 day after surgery, the content of S100β protein in two groups was significantly higher compared to preoperatively (F=4.621, F=4.233, P<0.05), and at the 2 and 3 day after surgery, the content of S100β protein in CH group was significantly higher than that in NCH group (F=8.202, F=7.625, P<0.05). The blood loss of CH group was significantly lower than that in NCH group (t=0.495, P<0.05). The content of S100β protein in all patients were closely related to the incidence of POCD (r=0.993, P<0.05). Conclusion Remifentanil controlled- hypotension used in elderly patients underwent spinal surgery can significantly reduce intraoperative blood loss, but enhance the content of S100β protein and increase incidence of POCD at early time.

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备注/Memo

备注/Memo:
基金项目：榆林市技术研究与发展计划项目（2014jh-20）
更新日期/Last Update: 2017-11-24