| 赵晓亮,吴新华,阿里木·司马义,等.急性等容血液稀释联合控制性降压对颅脑肿瘤手术病人脑氧代谢及早期认知功能的影响[J].安徽医药,2019,23(11):2170-2175. |
| 急性等容血液稀释联合控制性降压对颅脑肿瘤手术病人脑氧代谢及早期认知功能的影响 |
| Effect of acute normovolemic hemodilution combined with controlled hypotension on cerebral oxygen metabolism and early cognitive function in patients undergoing craniocerebral tumors surgery |
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| DOI：10.3969/j.issn.1009?6469.2019.11.013 |
| 中文关键词: 脑肿瘤 血液稀释 降压，控制性 脑氧代谢 认知功能 |
| 英文关键词: Brain neoplasms Hemodilution Hypotension,controlled Cerebral oxygen metabolism Cognitive function |
| 基金项目:国家自然科学基金资助项目( 81860345)；新疆维吾尔自治区自然科学基金资助项目( 2018D01C105)；新疆维吾尔自治区卫生计生委青年医学科技人才专项资助项目( WJWY?201849) |
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| 摘要点击次数: 1962 |
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| 中文摘要: |
| 目的评估急性等容血液稀释(ANH)联合控制性降压(CH)对颅脑肿瘤手术病人脑氧代谢及早期认知功能的影响。方法选取 2016年 1月至 2018年 6月新疆维吾尔自治区人民医院择期行外科手术治疗的颅脑肿瘤病人 120例，采用随机数字表法分为 3组: ANH+CH组( A组)、 ANH组( B组)和对照组( C组)。术中监测麻醉诱导前( T1)、血液稀释后 30 min(T2)、控制性降压后 30 min(T3)、术毕( T4)各个时间点脑氧代谢各相关指标，并计算获取动脉氧含量( CaO2)、颈内静脉氧含量( CjvO2)、动脉颈内静脉球部血氧差( Da?jvO2)和脑氧摄取率( CERO2)；通过简易精神状态量表( MMSE)对病人术前 1d和术后 1、4、7d的认知功能情况进行评估。结果脑氧代谢方面，与 T1比较，三组中， CaO2、CjvO2在 T2、T3、T4时间点是显著下降的( CaO2:A组: t＝3.009， 4.164，5.018，均 P＜0.05；B组: t＝3.224，5.152，6.832，均 P＜0.05；C组: t＝5.200，6.797，8.449，均P＜0.05)；(CjvO2:A组: t＝3.120，4.307，4.990，均 P＜0.05；B组: t＝3.175，5.544，7.271，均 P＜0.05；C组: t＝5.455，7.433，8.514，均 P＜0.05)。此外， B、C组中，与 T1比较， CERO2在 T3、T4时间点是显著上升的( B组: t＝2.592，3.165，均 P＜0.05；C组: t＝3.083，3.684，均 P＜0.05)。 T2和 T3时间点，与 A组比较， CaO2和 CjvO2在 C组中是显著下降的( T2:t＝2.488，3.335，均 P＜0.05；T3:t＝3.075，4.376，均 P＜0.05)；而 Da?jvO2和 CERO2在 C组中是显著上升的( T2:t＝2.260，2.008，均 P＜0.05；T3:t＝2.955，2.461，均 P＜0.05)； T4时间点，与 A组比较， CaO2、CjvO2在 B、C组中是显著下降的( CaO2:t＝2.017，3.878，均 P＜0.05；CjvO2:t＝2.735，4.831，均 P＜0.05)； Da?jvO2在 B、C组中是显著上升的( t＝2.135，2.971，均 P＜0.05)； CERO2在 C组中是显著上升的( t＝2.941，P＝0.004)。认知功能方面，与 A组比较，术后 1d、4d的 MMSE评分在 B、C组中是显著下降的(术后 1d:t＝3.156，5.669，均 P＜0.05；术后 4d:t＝2.513，4.406，均 P＜0.05)；术后 7d的 MMSE评分在 C组中是显著下降( t＝2.256，P＝0.027)。与术前 1d比较， A、B两组 MMSE评分在术后 1d、4d是显著下降的( A组: t＝6.248，2.325，均 P＜0.05；B组: t＝9.903，5.163，均 P＜0.05)； C组 MMSE评分在术后 1d、4d、7d是显著下降 |
| 英文摘要: |
| Objective To evaluate the effect of acute normovolemic hemodilution(ANH)combined with controlled hypotension(CH)on cerebral oxygen metabolism and early cognitive function in patients undergoing craniocerebral tumors surgery.Methods From January 2016 to June 2018，120 patients with craniocerebral tumors admitted to the Department of Neurosurgery in People’s Hospital of Xinjiang Uygur Autonomous Region were selected and randomly divided into 3 groups:AIH+CH group(A)，AIH group(B)and control group(C).Cerebral oxygen metabolism was monitored before anesthesia induction(T1)，30 minutes after hemodi? lution(T2)，30 minutes after controlled hypotension(T3)and after surgery(T4).The arterial oxygen content(CaO2)，oxygen con? tent of internal jugular vein(CjvO2)， venous oxygen content difference(Da?jvO2)and cerebral oxygen ex? traction rate(CERO2)were calculated.The cognitive function of the patients was assessed by Mini?Mental Status Scale(MMSE)1d before and 1 d，4 d and 7 d after operation.Results CaO2 and CjvO2 were significantly decreased at T2，T3 and T4 compared with T1(CaO2:A group:t＝3.009，4.164，5.018，all P＜0.05；B group:t＝3.224，5.152，6.832，all P＜0.05；C group:t＝5.200，6.797， arterialtojugularbulb，8.449，all P＜0.05)；(CjvO2:A group:t＝3.120，4.307，4.990，all P＜0.05；B group:t＝3.175，5.544，7.271，all P＜0.05；C group:t＝ 5.455，7.433，8.514，all P＜0.05).In addition，compared with T1，CERO2 were significantly higher at T3 and T4 in group B and group C(B group:t＝2.592，3.165，all P＜0.05；C group:t＝3.083，3.684，all P＜0.05).At T2 and T3，CaO2 and CjvO2 decreased in group C(T2:t＝2.488，3.335，all P＜0.05；T3:t＝3.075，4.376，all P＜0.05)，while Da?jvO2 and CERO2 increased in group C com? pared with group A(T2:t＝2.260，2.008，all P＜0.05；T3:t＝2.955，2.461，all P＜0.05).At T4，compared with A group，CaO2 and CjvO2 were decreased in B and C group(CaO2:t＝2.017，3.878，all P＜0.05；CjvO2:t＝2.735，4.831，all P＜0.05)Da?jvO2 were higher in group B and C(t＝2.135，2.971，all P＜0.05)，and CERO2 increased in group C(t＝2.941，P＝0.004Compared with group A，the MMSE of group B and C decreased on the 1 d and 4 d after operation(after operation 1d:t＝3.156，5.669，all P＜ )，0.05；after operation 4d:t＝2.513，4.406，all P＜0.05)，and the MMSE of group C decreased on the 7 d after operation(t＝2.256，P＝ 0.027).Compared with 1d before operation，the MMSE of group A and B decreased at 1d and 4 d after operation(A group:t＝ 6.248，2.325，all P＜0.05；B group:t＝9.903，5.163，all P＜0.05)，while those of group C decreased at 1 d，4 d and 7 d after opera? tion(t＝13.030，7.254，2.942，all P＜0.05).Conclusion For patients undergoing craniocerebral tumor surgery，the application ofANH combined with CH during operation can effectively maintain the balance of cerebral oxygen metabolism and improve the earlypostoperative cognitive function of patients. |
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