比较去氧肾上腺素与去甲肾上腺素对限制性输液老年患者组织氧代谢的影响

发布时间：2018-04-19 19:03

  本文选题：去氧肾上腺素 + 去甲肾上腺素　； 参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:加速康复外科(Enhanced Recovery After Surgery,ERAS)策略是围术期安全、有效的管理策略,液体管理作为麻醉管理中影响加速康复外科策略结果的关键因素,与患者术后肠道功能的早期恢复及并发症的发生相关。临床研究表明,限制性输液能够改善结直肠手术患者的预后,是符合加速康复外科理念的液体管理策略。限制性输液时可潜在亚临床低血压,影响组织灌注,小剂量去甲肾上腺素在限制性输液时对组织灌注的改善已得到验证。作为与去甲肾上腺素药理学特性相似的临床常用血管活性药物,去氧肾上腺素对限制性输液老年患者组织氧代谢的影响尚缺少相关临床研究。本研究对去氧肾上腺素对限制性输液老年患者组织氧代谢的影响进行观察,为老年患者结直肠道手术的液体管理提供参考。方法:选择60例择期行结直肠切除术的老年患者,随机分为去氧肾上腺素组(A组)和去甲肾上腺素组(B组)。患者入室后给予12m1·kg~(-1)乳酸钠林格液,继而以5m1·kg~(-1)·h~(-1)的速度输注,麻醉诱导后,A组术中给予负荷剂量去氧肾上腺素100μg,继而静脉输注小剂量去氧肾上腺素0.1-0.3μg·kg~(-1)·min~(-1)。B组则给予等效负荷剂量的去甲肾上腺素10μg,继而以0.01-0.03μg·kg~(-1)·min~(-1)输注去甲肾上腺素。围术期维持平均动脉压(Mean Arterial Pressure,MAP)≥65 mm Hg,以6%羟乙基淀粉130/0.4氯化钠注射液(Hydroxyethyl Starch Injection,HES)补充术中失血量。分别记录两组患者在术前(基础状态)、手术开始后1 h、2 h及出麻醉恢复室时4个时间点的MAP、HR和中心静脉压(Central Venous Pressure,CVP),同时分别采集动脉血和中心静脉血的血样,进行血气分析。记录患者Hb、血清白蛋白、尿素(BUN)、肌酐(Cr)在术前及术后24h的浓度。观察术后两组患者中伤口感染、肺部并发症和胃肠道并发症的发生情况。结果两组患者间的年龄、BMI、性别比例、ASA分级、失血量、尿量、补液量、手术时间、MAP、HR、CVP、Lac、Pa O2、Pcv O2、Scv O2差异无统计学意义。根据Fick公式计算:动脉血氧含量(Arterial oxygen content,Ca02)、静脉血氧含量(Central Venous oxygen content,Ccv02)、动脉-静脉血氧含量差(Difference of arteriovnous oxygen,Da-cv02)、氧摄取率(oxygen extraction rate,ER02),与B组相比,A组术中Hb、Ca O2、Ccv O2、Da-cv O2明显降低(P0.05),两组间ERO2差异无统计学意义。两组患者术后肾功能指标、肺部并发症和胃肠道并发症发生率差异无统计学意义。结论在老年患者结直肠手术中,去氧肾上腺素与去甲肾上腺素在围术期限制性输液时能很好的维持组织灌注和氧供,对组织功能影响较小,但与去氧肾上腺素相比,去甲肾上腺素对老年患者氧含量的影响较小。
[Abstract]:Objective: the strategy of accelerated Recovery After SurgeryERASis is a safe and effective management strategy in perioperative period. Fluid management is the key factor affecting the outcome of accelerated rehabilitation surgery strategy in anesthetic management. It is related to the early recovery of intestinal function and the occurrence of complications. Clinical studies have shown that restrictive infusion can improve the prognosis of patients undergoing colorectal surgery and is a fluid management strategy in accordance with the concept of accelerated rehabilitation surgery. The effect of low dose norepinephrine on subclinical hypotension and tissue perfusion during restricted infusion has been verified. As a common vasoactive drug similar to norepinephrine pharmacology, the effect of noradrenaline on tissue oxygen metabolism in elderly patients with restricted infusion has not been studied. In this study, we observed the effect of noradrenaline on tissue oxygen metabolism in elderly patients with restricted infusion, and provided reference for the fluid management of colorectal tract surgery in elderly patients. Methods: sixty elderly patients undergoing elective colorectal resection were randomly divided into noradrenaline group (group A) and norepinephrine group (group B). The patients were given 12m1 KGG (-1) lactate Ringer's solution after entering the room, and then were infused at the speed of 5m1 KGG (-1) HX ~ (-1). After anesthesia induction, group A received 100 渭 g of norepinephrine during operation, followed by intravenous infusion of 0.1-0.3 渭 g / kg of noradrenaline) min~(-1).B group received 10 渭 g of norepinephrine at an equivalent load dose, followed by 0.01-0.03 渭 g / min of norepinephrine. The mean arterial pressure (mean Arterial pressure MAPP) 鈮，

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