目的 探讨超声引导下腋静脉塌陷指数指导的补液对行腹腔镜下胆囊切除术老年患者苏醒期谵妄的影响。方法 选取2025年2月至5月在山西医科大学第一医院择期行腹腔镜下胆囊切除术的老年患者101例,随机分为试验组(n=51)和对照组(n=50),试验组采用腋静脉塌陷指数指导的补液,对照组采用常规补液。记录在麻醉前(T0)、麻醉后5 min(T1)、手术开始时(T2)、手术开始后30 min(T3)、手术结束时(T4)的平均动脉压(MAP)和心率(HR)。记录术前和术后乳酸值(Lac)、苏醒时间、输液总量、麻黄碱使用量、术中低血压发生情况;记录苏醒期谵妄发生率,术后1 h(T5)、24 h(T6)、48 h(T7)MMSE评分,术后24 h疼痛评分、首次下床活动时间和首次肛门排气时间、住院时间、术后恶心呕吐发生率,呼吸系统及心血管系统不良反应。结果 与对照组比较,T1时试验组MAP升高(P<0.05),术后Lac浓度降低(P<0.05),补液总量降低(P<0.05),低血压发生率及血管活性药物使用量均显著降低(P<0.05),T5时试验组MMSE 评分明显增高(P<0.05),苏醒期谵妄发生率下降(P<0.05),术后恶心呕吐发生率明显下降(P<0.05),首次下床活动时间和首次肛门排气时间均下降(P<0.05)。在认知功能正常亚组中,与对照组相比,试验组VAS评分明显降低(P<0.05),以上差异均具有统计学意义。结论 与常规补液相比,腋静脉塌陷指数指导的补液可以降低腹腔镜下胆囊切除术老年患者苏醒期谵妄发生率,减少术中低血压发生,改善患者术后疼痛、胃肠功能及早期预后。
Abstract
Objective To explore the effect of fluid resuscitation guided by axillary vein collapse index under ultrasound guidance on the delirium in elderly patients undergoing laparoscopic cholecystectomy. Methods A total of 101 elderly patients who underwent elective laparoscopic cholecystectomy at the First Hospital of Shanxi Medical University from February 2025 to May 2025 were selected and randomly divided into an experimental group (n=51) and a control group (n=50) . The experimental group received fluid resuscitation guided by axillary vein collapse index, while the control group received conventional fluid resuscitation. The mean arterial pressure (MAP) and heart rate (HR) were recorded at T0 (before anesthesia), T1 (5 minutes after anesthesia), T2 (at the start of surgery), T3 (30 minutes after the start of surgery), and T4 (at the end of surgery). The preoperative and postoperative lactate values (Lac), recovery time, total fluid volume, ephedrine usage, and incidence of intraoperative hypotension were recorded. The incidence of postoperative delirium, MMSE scores at T5 (1 hour after surgery), T6 (24 hours after surgery), and T7 (48 hours after surgery), postoperative pain scores at 24 hours, time to first ambulation, time to first flatus, hospital stay, and incidence of postoperative nausea and vomiting were also recorded. Adverse reactions in the respiratory and cardiovascular systems were recorded. Results Compared with the control group, the MAP in the experimental group increased at T1 (P<0.05), the postoperative Lac concentration decreased (P<0.05), the total fluid volume decreased (P<0.05), and the incidence of hypotension and the usage of vasoactive drugs were significantly reduced (P<0.05). At T5, the MMSE score of the experimental group increased significantly (P<0.05), the incidence of delirium decreased (P<0.05), the incidence of postoperative nausea and vomiting decreased significantly (P<0.05), and the time to first ambulation and first flatus decreased (P<0.05). In the subgroup with normal cognitive function, compared with the control group, the VAS score of the experimental group was significantly lower, and all these differences were statistically significant (P<0.05). Conclusions Compared with conventional fluid resuscitation, fluid resuscitation guided by axillary vein collapse index under ultrasound guidance can reduce the incidence of postoperative delirium in elderly patients undergoing laparoscopic cholecystectomy, decrease the incidence of intraoperative hypotension, improve postoperative pain and gastrointestinal function, and improve the early prognosis of patients.
关键词
腋静脉塌陷指数 /
苏醒期谵妄 /
液体管理 /
胆囊切除术
Key words
axillary vein collapse index /
delirium during awakening period /
fluid management /
cholecystectomy
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