参附注射液对全髋关节置换术老年患者术中血流动力学和E-选择素的影响

目的 探讨参附注射液对行全髋关节置换术的老年患者术中血流动力学和血浆E-选择素浓度的影响.方法 择期行全髋关节置换术老年患者24例,按随机数字表随机分为参附注射液组(S组)与生理盐水对照组(N组),每组12例.术前两组患者一般情况差异无统计学意义.S组:麻醉成功后予参附注射液0.2 ml/kg经外周静脉缓慢注射,继以0.8 ml·kg-1·h-1持续注入至手术结束;N组则以生理盐水替代.术后均予患者自控镇痛(PCEA).检测术前(T0)、手术结束即刻(T3)及术后24 h(T4)血浆E-选择素浓度.分别记录T0、术后15 min(T1)、术后30 min(T2)、T3各时间点心率、平均动脉压和中心静脉压.结果 两组患者手术时间、术中输液差异无统计学意义;两组血流动力学差异均无统计学意义(均P＞0.05);S组各时间点血浆E-选择素浓度差异均无统计学意义(均P＞0.05),N组在T3、T4时明显升高[(119±23)mg/L、(109±23)mg/L],与T0比较差异有统计学意义[(86±15)mg/L,P＜0.01],与S组比较明显高[T0、T3、T4分别为(92±37)、(83±15)、(83±12)mg/L,P＜0.05或0.01].结论 行全髋关节置换术的老年患者围术期血浆E-选择素浓度明显升高,参附注射液可以抑制其升高,抑制血管内皮细胞的活化,对血流动力学无明显的影响.

Abstract：

Objective To investigate the effects of Shenfu (SF) injection on hemodynamics and plasma E-selectin concentrations in elderly patients undergoing total hip replacement (THR). Methods A total of 24 ASA Ⅱ/Ⅲ patients aged 65 to 85 years old were divided equally into two groups (n = 12). In Group S, SF injection was administered by peripheral intravenous infusion at initially 0. 2 ml/kg and then patients received a post-operative regimen of patient-controlled epidural analgesia (PCEA). Blood samples were taken pre-operation ( T0), immediately post-operation (T3) and 24 hours post-operation (T4) so as to detect the levels of E-selectin at these time points.mean arterial pressure (MAP) , heart rate (HR) and central venous pressure (CVP) were continuously monitored and recorded at T0, 15 min post-anesthesia (T1 ), 30 min post-anesthesia (T2) and T3. Results The concentrations of E-selectin in Group N increased at T3 and T4 while those decreased in Group S [(119 ± 23 ) mg/L and(109 ± 23) mg/L vs (86 ±15)mg/L,(83 ±15)mg/L and (83 ±12)mg/L vs(92 ±37)mg/ L, all P＜0. 01]. As compared with Group S, they were significantly higher in Group N (P ＜ 0. 05 or 0. 01). There was no significant difference in CVP, HR and MAP between two groups. Conclusion The activation of vascular endothelial cells is manifested by an elevated plasma concentration of E-selectin in the elderly patients undergoing THR. SF injection can inhibit the activation and exert no significant effects on the hemodynamics.

Effects of Shenfu injection on hemodynamics and plasma E-selectin concentration in elderly patients undergoing total hip replacement surgery

Objective To investigate the effects of Shenfu (SF) injection on hemodynamics and plasma E-selectin concentrations in elderly patients undergoing total hip replacement (THR). Methods A total of 24 ASA Ⅱ/Ⅲ patients aged 65 to 85 years old were divided equally into two groups (n = 12). In Group S, SF injection was administered by peripheral intravenous infusion at initially 0. 2 ml/kg and then patients received a post-operative regimen of patient-controlled epidural analgesia (PCEA). Blood samples were taken pre-operation ( T0), immediately post-operation (T3) and 24 hours post-operation (T4) so as to detect the levels of E-selectin at these time points.mean arterial pressure (MAP) , heart rate (HR) and central venous pressure (CVP) were continuously monitored and recorded at T0, 15 min post-anesthesia (T1 ), 30 min post-anesthesia (T2) and T3. Results The concentrations of E-selectin in Group N increased at T3 and T4 while those decreased in Group S [(119 ± 23 ) mg/L and(109 ± 23) mg/L vs (86 ±15)mg/L,(83 ±15)mg/L and (83 ±12)mg/L vs(92 ±37)mg/ L, all P＜0. 01]. As compared with Group S, they were significantly higher in Group N (P ＜ 0. 05 or 0. 01). There was no significant difference in CVP, HR and MAP between two groups. Conclusion The activation of vascular endothelial cells is manifested by an elevated plasma concentration of E-selectin in the elderly patients undergoing THR. SF injection can inhibit the activation and exert no significant effects on the hemodynamics.