Effect of goal-directed fluid therapy on brain protection in elderly patients with old cerebral infarction undergoing beach chair position operation
LU Xiaoxing1 WANG Kai1 ZHOU Meiyan1 WANG Liuyi2 WANG Liwei1#br#
1.Department of Anesthesiology, Xuzhou Central Hospital, Jiangsu Province, Xuzhou 221009, China;
2.Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Jiangsu Province, Xuzhou 221004, China
Abstract：Objective To evaluate the effect of goal-directed fluid therapy (GDFT) on brain protection in elderly patients with old cerebral infarction undergoing beach chair position（BCP） operation. Methods From September 2020 to September 2021, a total of 152 elderly patients with old cerebral infarction who underwent shoulder arthroscopic operation under BCP in Xuzhou Central Hospital of Jiangsu Province were selected. According to the random number table method, they were divided into control group (group C) and GDFT group (group G), with 76 cases in each group. Group C was given routine fluid therapy; group G was given GDFT. Mean arterial pressure (MAP) and regional cerebral oxygen saturation (rScO2) between two groups were compared before anesthesia induction (T0), after tracheal intubation (T1), in BCP immediately (T2), in BCP for 30 min (T3), and back to supine position (T4); the content of serum S100β protein between two groups were compared before operation and one day after operation; operation time, intraoperative fluid volume, urine volume, use of vasoactive drugs, and incidence of postoperative cognitive dysfunction (POCD) were compared between two groups. Results Compared with T0, MAP decreased at T1-T4 in both groups, and the difference was highly statistically significant (P < 0.01); in group C, rScO2 increased at T1 and T4, and decreased at T2, and the differences were highly statistically significant (P < 0.01); rScO2 in group G increased at T1-T4, and the differences were statistically significant (P < 0.05 or P < 0.01); there were significant differences in MAP and rScO2 between two groups at T2-T4, and the differences were statistically significant (P < 0.05 or P < 0.01); rScO2 in group G was higher than that of group C, and the difference was statistically significant (P < 0.05). Compared with pre-operation, the serum S100β protein content of two groups was increased at 1 day after operation, and the difference was highly statistically significant (P < 0.01). One day after operation, the serum S100β protein content in group G was lower than that in group C, and the difference was highly statistically significant (P < 0.01). There was no significant difference in operation time between two groups (P > 0.05). Compared with group C, the amount of crystal fluid, total infusion volume, urine volume, and utilization rate of vasoactive drugs during operation in group G were decreased, while the amount of colloidal fluid was increased, and the differences were highly statistically significant (P < 0.01). The incidence of POCD in group G was lower than that in group C, and the difference was statistically significant (P < 0.05). Conclusion For elderly patients with old cerebral infarction undergoing BCP surgery, GDFT can effectively improve intraoperative cerebral hypoxia and reduce the occurrence of postoperative neurological complications, and play a certain role in brain protection.
陆筱星1 王凯1 周美艳1 王六一2 王立伟1. 目标导向液体治疗在陈旧性脑梗死老年患者沙滩椅体位手术中的脑保护作用[J]. 中国医药导报, 2022, 19(25): 98-102.
LU Xiaoxing1 WANG Kai1 ZHOU Meiyan1 WANG Liuyi2 WANG Liwei1. Effect of goal-directed fluid therapy on brain protection in elderly patients with old cerebral infarction undergoing beach chair position operation. 中国医药导报, 2022, 19(25): 98-102.
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