|
| 脑氧饱和度监测下控制性降压对老年高血压患者术后谵妄的影响 |
| Effects of controlled hypotension on postoperative delirium in elderly patients with hypertension under cerebral oxygen saturation monitoring |
| |
| DOI：10.12089/jca.2020.09.005 |
| 中文关键词: 脑氧饱和度 控制性降压 老年 谵妄 |
| 英文关键词: Cerebral oxygen saturation Controlled hypotension Elderly Delirium |
| 基金项目:徐州市科技计划项目（KC18030） |
|
| 摘要点击次数: 2517 |
| 全文下载次数: 671 |
| 中文摘要: |
目的 探讨脑氧饱和度(rSO2)监测下控制性降压对老年高血压患者术后谵妄（POD）的影响。
方法 择期全麻下行鼻泪道手术的老年高血压患者110例，男53例，女57例，年龄65~85岁，ASA Ⅱ或Ⅲ级，高血压Ⅰ或Ⅱ级，采用随机数字表法分为两组：rSO2监测组（S组）和对照组（C组），每组55例。两组均采用乌拉地尔联合艾司洛尔控制性降压，维持MAP≥基础值的70%，且MAP≥55 mmHg；当S组rSO2<基础值的80%或rSO2最低值<基础值的50%，并且持续时间大于10 s，则逐步提升血压直至rSO2恢复至≥基础值的80%或绝对值＞50%。C组rSO2监护仪施行遮盖处理。记录入室后吸氧5 min（T0）、控制性降压15 min（T1）、30 min（T2）、控制性降压结束后5 min（T3）、拔管后10 min（T4）的HR、MAP、rSO2；记录rSO2基础值、术中最低值及较基础值下降的最大百分比；术后1、2、3 d采用谵妄评定
方法 中文修订版（CAM-CR量表）对患者进行POD评估。
结果 与T0时比较，T1—T2时两组MAP明显下降（P<0.05），C组rSO2明显下降（P<0.05），T3—T4时逐渐回升至术前水平。T1—T2时S组rSO2明显高于C组（P<0.05），术中rSO2最低值明显高于C组（P<0.05），rSO2较基础值下降的最大百分比明显低于C组（P<0.05）。术后1 d S组POD发生率明显低于C组（P<0.05）。
结论 rSO2监测下控制性降压能减少老年高血压患者鼻泪道手术后谵妄的发生，提高围术期安全性。 |
| 英文摘要: |
Objective To explore the effect of controlled hypotension guided by cerebral oxygen saturation monitoring on postoperative delirium in elderly patients with hypertension.
Methods A total of 110 patients with hypertension, grade of hypertension Ⅰor Ⅱ, 53 males and 57 females, aged 65-85 years, ASA physical status Ⅱ or Ⅲ, were scheduled for nasolacrimal duct surgery and randomly divided into two groups (n = 55): group S and group C. Urapidil combined with esmolol was used for controlled hypotension in both groups, with maintaining MAP ≥ 70% of the baseline and MAP ≥ 55 mmHg. When the value of rSO2 in group S was lower than 80% of the baseline or the lowest value of rSO2 was less than 50%, and the duration was longer than 10 s, raising blood pressure gradually until rSO2 restored to the required range(≥ 80% of baseline or absolute value > 50%). The screen of rSO2 monitor was covered in group C. HR, MAP and rSO2 were recorded at 5 min oxygen inhalation after entering the room (T0), 15 min controlled hypotension (T1), 30 min controlled hypotension (T2), 5 min after controlled hypotension (T3) and 10 min after extubation (T4). The baseline of rSO2, the lowest intraoperative value and the largest percentage of decline from baseline were recorded. Postoperative delirium (POD) was assessed with the Chinese revised confusion assessment method (CAM-CR scale) at postoperative 1, 2, 3 d.
Results Compared with T0, MAP in both groups significantly decreased at T1-T2(P < 0.05), rSO2 was significantly decreased in group C (P < 0.05), rSO2 in group S was significantly higher than that in group C at T1-T2 (P < 0.05). rSO2 gradually returned to the preoperative level at T3-T4. The lowest value of rSO2 in group S was higher than in group C (P < 0.05), and the maximum percentage of rSO2 decline was lower than that in group C (P < 0.05). The incidence of POD in group S was lower than that in group C at postoperative 1 d (P < 0.05).
Conclusion Controlled hypotension guided by rSO2 monitoring can reduce the incidence of POD in elderly patients with hypertension and improve perioperative safety. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
