自血回输对老年脊柱手术患者术后认知功能的影响.docVIP

精品论文 参考文献 自血回输对老年脊柱手术患者术后认知功能的影响 1 湖南郴州市第四人民医院骨科 423000；2 湖南常德市第一人民医院麻醉科 415000 【摘 要】目的 探讨术中自体血回输对老年患者脊柱手术术后认知功能的影响。方法 择期50例全麻下行脊柱手术老年患者随机分成2组：对照组（A组）和自血回输组（B组），性别不拘，体重指数20-25 kg／m2，ASA分级I 到Ⅱ级，记录麻醉诱导前即刻（T0）、苏醒后30min（T1）、1h（T2）、5h（T3）、12h（T4）、24h（T5）MMSH评分，评估术后认知功能障碍（POCD发生率，抽取颈内静脉血ELASA法检测IL-6，IL-8含量。结果 两组间年龄、性别、体重指数、受教育程度、手术时长、输液量、出血量，苏醒时间无区别，B组异体血输入明显少于A组。两组MMSH评分，IL-6，IL-8含量均在苏醒后30min最高，随着时间延长逐渐下降（Plt;0.05），12h、24h时与诱导前已无明显区别（Pgt;0.05），B组MMSH评分在T1，T2，T3均小于A组，而，IL-6，IL-8含量则更高。两组各时间点POCD发生率无明显差异（Pgt;0.05）。IL-6，IL-8含量与MMSH评分苏醒后5h内呈显著负相关（Plt;0.05）。结论 自体血回输对老年患者脊柱手术术后短暂认知功能有显著影响，但是不增加POCD发生率。 【关键词】输血，自体；老年；认知功能障碍 【Abstract】Objective To evaluate the effect of autologous blood withdrawal-reinfusion on postoperative cognitive function in old patients undergoing spinal surgery.Methods fifty patients of both sexes，aged 65-80yr，with body mass index 20-25 kg／m2，of ASA physical status I orⅡ，scheduled for elective spinal surgery under general anesthesia，were randomly divided into 2 groups（n=25 each）：control group（group A）and autologous blood withdrawal-reinfusion group（group B）.Immediately before Anesthesia was induced（To，baseline），and at 30min、1h、5h、12h and 24h after awakening（T1-5），MMSH were evaluated and postoperative cognitive dysfunction were calculated，blood samples were collected from the Jugular vein for measurement of IL-6，IL-8 level.Result There were no deference between the two groups of normal information（Age，gender，body mass index，education level，length of surgery，fluid volume，blood loss，recovery time），allogeneic blood were Significantly less inputted in group B，The MMSH Score and the level of IL-6，IL-8 were highest at T3，gradually decreased with time（Plt;0.05），no deference at T4，T5（Pgt;0.05），and the difference was not statistically significant of the incidence of POCD between two groups，The level of IL-6，IL-8 were higher，but the MMSH were lower in group B.There were significant negative correlation between level of IL-6 or IL-8 and MMSH Within 5 hours after a