晶体预扩容和胶体预扩容对老年病人无痛肠镜血流动力学和术后早期认知功能的影响

doi:10.3969/j.issn.1003-9198.2025.09.007

摘要/Abstract

摘要： 目的观察晶体预扩容和胶体预扩容对老年病人无痛肠镜血流动力学和术后早期认知功能的影响。方法纳入2021年12月至2023年3月在安徽医科大学第一附属医院接受无痛肠镜检查的80例老年病人,采用随机数表法将其分为晶体组(n=40)和胶体组(n=40)。晶体组术前30 min予乳酸钠林格液2 mL/kg静脉滴注,胶体组术前30 min予羟乙基淀粉氯化钠2 mL/kg静脉滴注,2组均根据超声测量下腔静脉呼吸变异度(ΔIVC)动态评估容量状态,确定后续补液量,直至ΔIVC≤30%。比较2组病人不同时间点的平均动脉压(MAP)、心率(HR),苏醒时间、定向力恢复时间,术后头晕、恶心、口渴的发生率,以及术前和术后清醒时的MoCA评分。结果 2组病人补液前后MAP、HR差异无统计学意义(P>0.05);麻醉后1 min,2组病人的MAP、HR均较麻醉前显著下降(P<0.05),且晶体组MAP较胶体组下降更多,差异有统计学意义(P<0.05);术毕时,2组病人的MAP和HR均较麻醉后1 min显著提高(P<0.05),且2组病人的MAP与麻醉前相比,差异无统计学意义(P>0.05),但晶体组的HR仍低于麻醉前(P<0.05)。2组病人术后苏醒时间、定向力恢复时间、术后头晕及恶心的发生率比较,差异均无统计学意义(P>0.05)。胶体组术后口渴、低血压发生率低于晶体组,MoCA评分高于晶体组,差异均有统计学意义(P<0.05)。结论相较于晶体预扩容,无痛肠镜前胶体预扩容对老年病人血流动力学的稳定作用更显著,减少术后口渴的发生率,且对术后早期认知功能的影响较小。

关键词: 无痛肠镜, 老年人, 晶体液, 胶体液, 血流动力学, 术后认知功能

Abstract: Objective To investigate the effects of crystalloid preloading and colloid preloading on hemodynamics and early postoperative cognitive function in the elderly patients undergoing painless colonoscopy. Methods Eighty elderly patients who underwent painless colonoscopy at the First Affiliated Hospital of Anhui Medical University from December 2021 to March 2023 were enrolled in this study. The patients were randomly assigned into the crystalloid group (n=40) and the colloid group (n=40) using a random number table. The crystalloid group received 2 mL/kg sodium lactate ringer’s injection via intravenous infusion 30 minutes before the procedure, while the colloid group received 2 mL/kg of hydroxyethyl starch under the same conditions. The fluid volume was dynamically adjusted based on ultrasound assessment of inferior vena cava respiratory variation (ΔIVC) until ΔIVC ≤ 30%. The mean arterial pressure (MAP) and heart rate (HR) at different time points, as well as awakening time, orientation recovery time, incidence of postoperative dizziness, nausea, thirst, and Montreal Cognitive Assessment (MoCA) scores before and after the operation were compared between the two groups. Results There were no significant differences in MAP and HR between the two groups before and after fluid administration (P>0.05). After anesthesia, the levels of MAP and HR in both groups decreased significantly compared to those before anesthesia (P<0.05), with the crystalloid group showing a greater decline in MAP than the colloid group (P<0.05). Postoperatively, the levels of MAP and HR in both groups increased significantly compared to those after anesthesia (P<0.05), but the level of HR in the crystalloid group was still significantly lower than that before anesthesia (P<0.05). There were no significant differences in awakening time, orientation recovery time, and the incidence rates of postoperative dizziness and nausea between the two groups (P>0.05). However, the colloid group had lower incidence rates of postoperative thirst and of hypotension, and a higher MoCA score than the crystalloid group (P<0.05). Conclusions Compared with crystalloid preloading, colloid preloading before painless colonoscopy in the elderly patients demonstrates a more significant stabilizing effect on hemodynamics, reduces the incidence of postoperative thirst, and exerts a milder impact on early postoperative cognitive function.

Key words: painless colonoscopy, aged, crystalloid, colloid, hemodynamics, postoperative cognitive function

中图分类号:

R 619

章雨雯, 陈立建. 晶体预扩容和胶体预扩容对老年病人无痛肠镜血流动力学和术后早期认知功能的影响[J]. 实用老年医学, 2025, 39(9): 894-898.

ZHANG Yuwen, CHEN Lijian. Effects of crystalloid preloading and colloid preloading on hemodynamics and early postoperative cognitive function in elderly patients undergoing painless colonoscopy[J]. Practical Geriatrics, 2025, 39(9): 894-898.

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