文章摘要
目标导向液体治疗对缺血型烟雾病患者脑血管重建术后谵妄的影响
Effect of goal directed fluid therapy on the incidence of postoperative delirium after cerebral revascularization for ischemic moyamoya disease
  
DOI：10.12089/jca.2020.01.003
中文关键词: 目标导向液体治疗  谵妄  缺血型烟雾病；脑血管重建术
英文关键词: Goal directed fluid therapy  Delirium  Ischemic moyamoya disease  Cerebral revascularization
基金项目:2015年度脑功能与脑疫病安徽省重点实验室开放课题项目（BFBD201502）
作者单位E-mail
黄祥 230036,合肥市,中国科学技术大学附属第一医院,安徽省立医院麻醉科  
韩明明 230036,合肥市,中国科学技术大学附属第一医院,安徽省立医院麻醉科  
殷国兵 230036,合肥市,中国科学技术大学附属第一医院,安徽省立医院麻醉科  
康芳 230036,合肥市,中国科学技术大学附属第一医院,安徽省立医院麻醉科  
李娟 230036,合肥市,中国科学技术大学附属第一医院,安徽省立医院麻醉科 huamuzi1999@126.com 
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中文摘要:
      
目的 探讨目标导向液体治疗对缺血型烟雾病患者脑血管重建术后谵妄(POD)的影响。
方法 择期行颞浅动脉-大脑中动脉分支吻合术的缺血型烟雾病患者40例,男24例，女16例，年龄18～59岁,BMI 18.5～24.0 kg/m2,ASA Ⅱ或Ⅲ级,Suzuki分期≥3,MMSE评分>24分。采用随机数字表法将其分为两组(n=20):常规补液组(R组)和目标导向液体治疗组(G组)。R组采用常规4-2-1补液原则,维持CVP 5～10 cmH2O;G组采用目标导向液体治疗,维持每搏量变异度(SVV)<10％。两组维持MAP波动幅度在基础值20％以内,MAP下降幅度超过基础值20％以上时,静脉注射麻黄碱6～10 mg或输注去甲肾上腺素0.01～0.03 μg·kg-1·min-1。记录麻醉诱导前即刻(T0)、血管阻断前10 min(T1)、阻断后10 min(T2)、血管开放后10 min(T3)时的局部脑氧饱和度(rSO2)、MAP、HR、BIS值、鼻咽温。于T1—T3时采集动脉血样1 ml,行血气分析,并测定Hct和PaCO2。于术后3 d,采用CAM量表评估患者POD的发生情况。
结果 两组不同时点MAP、HR、鼻咽温、BIS值、Hct和PaCO2差异无统计学意义;与T0时比较,T1—T3时G组患者两侧rSO2明显升高,T3时R组患侧rSO2明显升高(P<0.05);与R组比较,T1—T3时G组患者两侧rSO2明显升高(P<0.05)。与R组比较,G组患者补液量明显减少,POD发生率明显降低(P<0.05)。
结论 目标导向液体治疗可降低缺血型烟雾病患者脑血管重建术后POD的发生率,其机制可能与改善rSO2有关。
英文摘要:
      
Objective To evaluate the effect of goal directed fluid therapy on the incidence of postoperative delirium after cerebral revascularization for ischemic moyamoya disease.
Methods Forty patientsm, 24 males and 16 females, aged 18-59 yr with a BMI of 18.5-24.0 kg/m2, Suzuki ≥ 3, MMSE > 24 undergoing superficial temporal artery-middle cerebral artery anastomosis were divided into routine fluid replacement group (group R) and goal directed fluid therapy (group G) using a random number table. Group R was treated with 4-2-1 rehydration principle and CVP 5-10 cmH2O was maintained, whereas group G was treated with goal directed fluid therapy, with stroke volume variability (SVV) as a guide, and SVV<10％ was maintained. The amplitude of MAP fluctuation was maintained within 20％ of the baseline level, when MAP decreased more than 20％, ephedrine 6-10 mg or norepinephrine 0.01-0.03 μg·kg-1·min-1 were injected or infused intravenously. Regional cerebral oxygen saturation (rSO2), MAP, HR, BIS and nasopharyngeal temperature were recorded immediately before anesthesia induction (T0), 10 minutes before and after blood vessel was clamped (T1 and T2), and 10 min after anastomosis was completed (T3). At T1-T3, 1 ml of arterial blood was collected, blood gas analysis was performed, Hct and PaCO2 were measured. The incidence of postoperative delirium (POD) was assessed by CAM method 3 d after operation.
Results There was no significant difference in MAP, HR, nasopharyngeal, BIS, HCT and PaCO2 in various time points between the two groups. Compared with T0, rSO2 increased in both sides in group G at T1-T3 and at T3 in group R (P<0.05). Compared with group R, rSO2 increased in both sides in group G at T1-T3 (P<0.05). The fluid transfusion volume and the incidence of POD in group G was lower than that in group R (P<0.05).
Conclusion Goal directed fluid therapy can reduce the incidence of POD after cerebral revascularization for ischemic moyamoya disease, and the mechanism may be related to the improvement of rSO2.
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