Effect of Goal-directed Fluid Therapy on Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Combined Lingual and Cervical Radical Surgery

IF 0.4 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Iranian Red Crescent Medical Journal Pub Date : 2023-03-31 DOI:10.32592/ircmj.2023.25.6.2676
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Abstract

Background: The intraoperative rehydration technique known as the effect of Goal-Directed Fluid Therapy (GDFT), which is guided by the dynamic monitoring of volume responsiveness, has received a lot of attention recently. According to a meta-analysis by Bene, GDFT can maintain intraoperative hemodynamic stability, which lowers the incidence of postoperative complications and reduces stay at the intensive care unit. Objectives: This study aimed to determine how GDFT affected elderly patients who underwent combined lingual and cervical radical surgery after an operation for postoperative cognitive dysfunction (POCD). Methods: This interventional study was conducted between December 2021 and December 2022 in a medical center affiliated with Fujian Medical University on people undergoing radical neck and tongue surgery for tongue cancer. The samples (n=36) were selected using an availability sampling method and randomly divided into conventional fluid therapy (the Non-GDFT, n=18) and GDFT (n=18) groups. The Non-GDFT group was hydrated normally during anesthesia. A continuous infusion of 8 mL/(kg/h) of compounded sodium chloride was administered to the GDFT group to maintain basal hydration volume during the operation. Before and following surgery, Montreal Cognitive Assessment Scale scores were completed, arterial blood lactate values and bilateral cerebral oxygen saturation levels were measured at various times following the stabilization of anesthesia, and the levels of interleukin 6 (IL-6) and S100 protein in venous blood were calculated. Results: The Non-GDFT group had a higher incidence of POCD than the GDFT group, the GDFT group had significantly lower levels of IL-6 and S100 than the Non-GDFT group, the GDFT group had significantly lower levels of serum lactate than the Non-GDFT group. The GDFT group experienced significantly lower rates of intraoperative hypotensive and intraoperative low rSO2 events than the Non-GDFT group, and this difference was statistically significant (P<0.05). Conclusion: Assuring the balance of cerebral oxygen supply and demand, lowering the production of inflammatory mediators, and successfully reducing the incidence of POCD are all possible benefits of GDFT.
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定向液体疗法对老年舌颈联合根治术患者术后认知功能障碍的影响
背景:术中补液技术被称为目标导向液体疗法(GDFT)的效果,它以动态监测体积反应性为指导,最近受到了很多关注。根据Bene的meta分析,GDFT可以维持术中血流动力学的稳定性,从而降低术后并发症的发生率,减少在重症监护病房的停留时间。目的:本研究旨在确定GDFT对术后认知功能障碍(POCD)手术后行舌颈联合根治术的老年患者的影响。方法:本介入研究于2021年12月至2022年12月在福建医科大学附属医疗中心对接受根治性颈部和舌癌手术的患者进行。采用可得性抽样法选取样本(n=36),随机分为常规液体治疗组(非GDFT组,n=18)和GDFT组(n=18)。非gdft组麻醉期间正常补水。GDFT组持续输注复合氯化钠8 mL/(kg/h),维持术中基础水合体积。术前、术后完成蒙特利尔认知评估量表评分,麻醉稳定后各时间测量动脉血乳酸值和双侧脑氧饱和度,计算静脉血中白细胞介素6 (IL-6)和S100蛋白水平。结果:非GDFT组POCD发生率高于GDFT组,GDFT组IL-6、S100水平显著低于非GDFT组,GDFT组血清乳酸水平显著低于非GDFT组。GDFT组术中低血压和低rSO2事件发生率明显低于Non-GDFT组,差异有统计学意义(P<0.05)。结论:保证脑氧供需平衡,降低炎症介质的产生,成功降低POCD的发生率是GDFT可能带来的益处。
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来源期刊
Iranian Red Crescent Medical Journal
Iranian Red Crescent Medical Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
1.16
自引率
0.00%
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0
期刊介绍: The IRANIAN RED CRESCENT MEDICAL JOURNAL is an international, English language, peer-reviewed journal dealing with general Medicine and Surgery, Disaster Medicine and Health Policy. It is an official Journal of the Iranian Hospital Dubai and is published monthly. The Iranian Red Crescent Medical Journal aims at publishing the high quality materials, both clinical and scientific, on all aspects of Medicine and Surgery
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