持续泵注小剂量去甲肾上腺素对单肺通气患者血乳酸及心肌酶的影响

发布时间：2018-10-17 09:26

【摘要】：目的探讨持续泵注小剂量去甲肾上腺素对单肺通气患者血乳酸及心肌酶的影响。方法选择在单肺通气下行肺叶切除术患者60例,随机分成小剂量去甲肾上腺素组(N组)和多巴胺组(D组),每组30例。术前补足禁食禁水、生理需要量,晶体与胶体按2:1给予,晶体为生理盐水,胶体为琥珀酰明胶注射液,N组于麻醉诱导即刻持续泵注小剂量去甲肾上腺素[0.01~0.03μg/(kg·min)],D组于麻醉诱导即刻持续泵注多巴胺[1~3μg/(kg·min)]。两组根据患者基础平均动脉压在上述范围内调整去甲肾上腺素、多巴胺及麻醉药物泵注速率使平均动脉压维持在基础值±30%,脑电双频指数(BIS)值45~60。如血压仍不能维持,单次给予静脉注射去甲肾上腺素10μg,多巴胺1 mg,分别于诱导前(T0)、诱导后(T1)、单肺通气即刻(T2)、单肺通气30 min(T3)、单肺通气90 min(T4)、手术结束即刻(T5)时间点取桡动脉血行血气分析记录血乳酸含量,上述各时间点及术后24 h(T6)取中心静脉血检测心肌酶[乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)]浓度,记录各组患者手术后自然苏醒时间(手术结束至能按指令睁眼时间)。结果各组内与T0~T3比较,T4~T5动脉血乳酸含量显著升高,T5~T6时刻LDH、α-HBDH、CK及CK-MB浓度均比T0~T4时刻显著升高,但均在正常范围内;组间比较两组血乳酸含量在T0~T4时刻差异无统计学意义(P0.05),在T5时刻N组明显低于D组;平均术后自然苏醒时间N组明显短于D组;心肌酶含量两组比较差异无统计学意义(P0.05)。结论持续泵注小剂量去甲肾上腺素能增加单肺通气患者血乳酸清除,缩短患者自然苏醒时间且对心肌酶无不利影响。
[Abstract]:Objective to investigate the effects of low dose norepinephrine on blood lactic acid and myocardial enzymes in patients undergoing single lung ventilation. Methods Sixty patients undergoing lobectomy under single lung ventilation were randomly divided into two groups: low dose norepinephrine group (group N) and dopamine group (group D) with 30 cases in each group. Before operation, supplement fasting water, physiological requirements, lens and colloid according to 2:1, the lens is normal saline, The colloid was succinyl gelatin injection. Group N was injected with low dose of norepinephrine (0.01g / (kg min) immediately after anesthesia induction, and group D was injected with dopamine (1 3 渭 g / (kg min) immediately after induction of anesthesia. The two groups adjusted norepinephrine, dopamine and anaesthetic pump injection rate to maintain the mean arterial pressure at base 卤30, and EEG bispectral index (BIS) 45 ~ 60. If the blood pressure is still not maintained, Single intravenous injection of norepinephrine 10 渭 g, dopamine 1 mg, before (T0), after induction (T1), immediately after one-lung ventilation (T2), 30 min of single-lung ventilation (T3), 90 min of single-lung ventilation (T4), blood gas analysis of radial artery at the end of operation (T5) The content of lactic acid in blood was recorded. Myocardial enzyme (LDH), 伪 -hydroxybutyrate dehydrogenase (CK-MB) was measured at each time point and 24 h after operation (T6), and the concentration of (CK), creatine kinase isoenzyme (CK-MB) was measured. The time of spontaneous recovery after operation (from the end of operation to the time of opening eyes as instructed) was recorded. Results compared with T0~T3, the content of lactic acid in arterial blood of T4~T5 was significantly increased, and the concentrations of LDH, 伪-HBDH,CK and CK-MB in T5~T6 were significantly higher than those in T0~T4, but they were within the normal range. There was no significant difference in blood lactic acid content between the two groups at T0~T4 time (P0.05). At T5 time N group was significantly lower than D group; the average postoperative spontaneous recovery time in N group was significantly shorter than that in D group; there was no significant difference in myocardial enzyme content between the two groups (P0.05). Conclusion continuous infusion of low dose norepinephrine can increase the clearance of blood lactic acid in patients with single lung ventilation, shorten the time of spontaneous recovery and have no adverse effect on myocardial enzymes.
【作者单位】：南昌大学研究生院医学部;南昌大学第一附属医院麻醉科;
【分类号】：R614

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