【摘要】：目的;觀察瑞芬太尼控制性降壓(CH)對(duì)老年脊柱手術(shù)患者術(shù)后認(rèn)知功能障礙(POCD)和血清SlOOβ蛋白的影響,并考察二者的相關(guān)性。方法:前瞻性選擇2014年1月-2015年12月我院骨科擬擇期全身麻醉下行腰椎或胸椎骨折椎板減壓內(nèi)固定術(shù)的老年患者60例,采用隨機(jī)數(shù)字表法分為CH組與非CH組,各30例。兩組患者均采用氣管內(nèi)插管靜脈吸入復(fù)合全身麻醉;CH組患者通過調(diào)整鹽酸瑞芬太尼泵注速率,使平均動(dòng)脈壓(MAP)降至基礎(chǔ)值的70%~80%;非CH組則維持MAP基礎(chǔ)值。觀察兩組患者手術(shù)時(shí)間、麻醉時(shí)間、術(shù)中失血量、術(shù)后POCD發(fā)生率、血清S100β蛋白濃度,分析血清S100β蛋白濃度與POCD發(fā)生率的相關(guān)性,并記錄不良反應(yīng)發(fā)生情況。結(jié)果:CH組患者術(shù)中失血量明顯少于非CH組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)后第1、7天POCD發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);CH組患者術(shù)后第2、3天POCD發(fā)生率和血清S100β蛋白濃度均明顯高于非CH組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。患者的POCD發(fā)生率可能與血清S100β蛋白濃度存在相關(guān)性(r=0.992 7,P=0.001 3)。結(jié)論:瑞芬太尼CH用于老年脊柱手術(shù)患者,可減少術(shù)中失血量,但增加了血清S100β蛋白濃度且升高了術(shù)后早期POCD發(fā)生率。
[Abstract]:Aim: to observe the effect of remifentanil-controlled hypotensive (CH) on cognitive dysfunction (POCD) and serum SlOO-尾 protein in aged patients after spinal surgery, and to investigate the correlation between remifentanil and remifentanil. Methods: from January 2014 to December 2015, 60 elderly patients with lumbar or thoracic fracture were prospectively divided into CH group and non-CH group (30 cases in each group) under general anesthesia for decompression and internal fixation of lumbar or thoracic vertebral fractures. The patients were randomly divided into two groups: one group (n = 30) and the other group (n = 30, n = 30). The mean arterial pressure (MAP) was reduced to 70% / 80% of the basic value in the CH group by adjusting the infusion rate of remifentanil hydrochloride, while the MAP basal value was maintained in the non-CH group. The operative time, anesthesia time, intraoperative blood loss, postoperative POCD incidence and serum S100 尾 protein concentration were observed. The correlation between the serum S100 尾 protein concentration and the incidence of POCD was analyzed, and the incidence of adverse reactions was recorded. Results: the amount of blood loss in CH group was significantly lower than that in non-CH group (P0.05). There was no significant difference in the incidence of POCD between the two groups on the 1st and 7th day after operation (P0.05). The incidence of POCD and the concentration of serum S100 尾 protein on the 2nd and 3rd day after operation in the); CH group were significantly higher than those in the non-CH group, and the difference was statistically significant (P0.05). The incidence of POCD may be correlated with the concentration of serum S100 尾 protein (r = 0.9927, P < 0.001 3). Conclusion: remifentanil CH can reduce blood loss, but increase the concentration of serum S100 尾 protein and increase the incidence of early postoperative POCD.
【作者單位】： 榆林市第一醫(yī)院麻醉科;
【基金】：榆林市科技計(jì)劃項(xiàng)目(No.2014jh-20)
【分類號(hào)】：R614.2

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