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

目的评价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。方法择期行结(直)肠切除术的老年患者60例,男35例,女25例,年龄65~80岁,BMI 18~24kg/m~2,ASAⅠ或Ⅱ级。采用随机数字表法,将其随机均分为两组:去氧肾上腺素复合限制性输液组(A组)和去甲肾上腺素复合限制性输液组(B组)。A组术中静脉输注复方乳酸钠5ml·kg~(-1)·h~(-1),同时静脉输注小剂量去氧肾上腺素0.1~0.3μg·kg~(-1)·min~(-1),维持MAP≥65mm Hg,术中失血量以等容量6%羟乙基淀粉130/0.4氯化钠注射液补充。B组则静脉输注小剂量去甲肾上腺素0.01~0.03μg·kg~(-1)·min~(-1)。分别于术前(基础状态,T_0)、手术开始后1h(T_1)、2h(T_2)及出麻醉恢复室时(T_3)记录MAP、HR和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,测定术前及术后1d的Hb、血清白蛋白、尿素氮(BUN)、肌酐(Cr)的浓度。记录术后肺部并发症、胃肠道并发症和伤口感染等的发生情况。结果与B组比较,T_1~T_3时A组Hb、动脉血氧含量(CaO2),T_1、T_3时静脉血氧含量(CcvO_2),T_2时动脉静脉血氧差(Da-cvO_2)明显降低(P0.05);两组MAP、HR、CVP、血乳酸(Lac)、PaO_2、中心静脉血氧分压(PcvO_2)、中心静脉血氧饱和度(ScvO_2)、氧摄取率(ERO_2)、BUN、Cr、咳嗽、咳痰、呼吸急促或呼吸困难、肺部感染和肺不张等肺部并发症和恶心呕吐、腹胀和肠鸣音消失等胃肠道并发症发生率差异无统计学意义。结论去氧肾上腺素对限制性输液老年患者组织氧代谢的影响大于去甲肾上腺素。

Comparison of the effects of phenylephrine and norepinephrine on tissue oxygen metabolism in elderly pa-tients undergoing fluid-restricted

[Abstract ] Objective To investigate the effects of norepinephrine on tissue oxygen metabolism in elderly patients undergoing fluid-restricted.Methods After hospital ethics committee approval,and written informed consent was obtained from all patients,60 elderly patients,male 35 ca-ses,female 25 cases,aged 65-80 years,with BMI of 18-24 kg/m2 ,undergoing elective colorectal sur-gery,were randomly divided into two groups:phenylephrine combine restricted fluid administration group (group A) and norepinephrine combine restricted fluid administration group (group B). Lactated Ringer??s solution was given at a rate of 5 ml·kg-1 ·h-1 and small dose of Phenylephrine was infused intravenously at 0.1-0.3 μg · kg-1 · min-1 simultaneously during the surgery (group A),or norepinephrine 0.01-0.03 μg · kg-1 · min-1 (group B),and MAP was maintained ≥ 65 mm Hg.Intraoperative blood loss was replaced with the equal volume of 6% hydroxyethyl starch 130/0.4.Before the surgery (baseline),1 h and 2 h after beginning of the surgery,and while leaving post-anesthesia care unit,MAP, HR and CVP were recorded,and arterial and central venous blood samples were drawn for blood gas analysis.Blood samples were taken from the peripheral vein to de-termine the concentration of Hb,blood urea nitrogen(BUN)and creatinine(Cr)before the surgery and 1 day after the surgery.Pulmonary complications,gastrointestinal complications,and wound infections were recorded.Results Compared with group B,CaO 2 ,CcvO 2 ,Da-cvO 2 and Hb were significantly decreased(P <0.05).There were no significant differences in MAP,HR,CVP,Lac,PaO 2 ,PcvO 2 , ScvO 2 ,ERO 2 ,BUN,Cr and the incidence of postoperative pulmonary complications and gastrointes-tinal complications between the two groups.Conclusion Phenyphrine has more effect on tissue oxygen metabolism in the elderly patients undergoing fluid-restricted abdominal surgery.