急性等容血液稀释对老年脊柱手术患者麻醉效果、血浆浓度和恢复质量的影响。

Effect of acute normovolemic hemodilution on anesthetic effect, plasma concentration, and recovery quality in elderly patients undergoing spinal surgery.

机构信息

Department of Anesthesiology and Perioperative Medicine, Shanghai Gongli Hospital, Naval Military Medical University, No.219 Miaopu Road, Pudong New Area, Shanghai, 200135, China.

出版信息

BMC Geriatr. 2023 Oct 24;23(1):689. doi: 10.1186/s12877-023-04397-w.

DOI:10.1186/s12877-023-04397-w

PMID:37875833

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10598930/

Abstract

OBJECTIVE

To explore the effect of acute normovolemic hemodilution (ANH) on the anesthetic effect, plasma concentration, and postoperative recovery quality in elderly patients undergoing spinal surgery.

METHODS

A total of 60 cases of elderly patients aged 65 to 75 years who underwent elective multilevel spinal surgery were assigned randomly into the ANH group (n = 30) and control group (n = 30). Hemodynamic and blood gas analysis indexes were observed and recorded before ANH (T), after ANH (T), immediately after postoperative autologous blood transfusion (T), 10 min (T), 20 min (T), 30 min (T), 40 min (T), and 50 min (T) after the transfusion, and at the end of the transfusion (i.e., 60 min; T). At T, bispectral index (BIS) and train-of-four (TOF) stimulation were recorded and the plasma propofol/cisatracurium concentration was determined. The extubation time and recovery quality were recorded.

RESULTS

The ANH group presented a lower MAP value and a higher SVV value at T, and shorter extubation and orientation recovery time (P < 0.05) compared with the control group. BIS values at T and T were lower in the ANH group than those in the control group (P < 0.05). TOF values at T were lower in the ANH group than those in the control group (P < 0.05). There were no statistically significant differences in the postoperative plasma concentrations of propofol and cisatracurium between the groups (P > 0.05).

CONCLUSION

During orthopedic surgery, the plasma concentration of elderly patients is increased after autologous blood transfusion of ANH, and the depth of anesthesia and muscle relaxant effect are strengthened, thus leading to delayed recovery of respiratory function and extubation.

摘要

目的

探讨急性等容血液稀释（ANH）对老年脊柱手术患者麻醉效果、血浆浓度和术后恢复质量的影响。

方法

选择择期行多节段脊柱手术的 65~75 岁老年患者 60 例，随机分为急性等容血液稀释（ANH）组（n=30）和对照组（n=30）。观察并记录 ANH 前（T）、ANH 后（T）、术后自体输血即刻（T）、输血后 10 min（T）、20 min（T）、30 min（T）、40 min（T）、50 min（T）和输血结束时（即 60 min；T）的血流动力学和血气分析指标。记录 T 时的脑电双频指数（BIS）和四成串刺激（TOF）刺激，测定血浆丙泊酚/顺式阿曲库铵浓度。记录拔管时间和恢复质量。

结果

与对照组相比，ANH 组 T 时 MAP 值较低，SVV 值较高，拔管和定向恢复时间较短（P<0.05）。与对照组相比，ANH 组 T 和 T 时 BIS 值较低（P<0.05）。与对照组相比，ANH 组 T 时 TOF 值较低（P<0.05）。两组患者术后血浆丙泊酚和顺式阿曲库铵浓度无统计学差异（P>0.05）。