控制降压对胃粘膜pH及胃肠功能的影响

目的观察不同的液体输注下控制性降压对胃粘膜pH及术后胃肠功能的影响，并探讨其影响机制。方法选择ASAⅡ级、择期行肝癌手术患者45例，随机分为三组，分别输入不同的液体并控制性降压：R组输入乳酸林格氏液；H组输入6％贺斯；W组输入6％万汶。用Tonocap监护仪分别于控制性降压前、降压后1h、降压后2h、停止降压后1h测定胃内PgCO2和pHi；同时在各时间点抽取动脉血行血气分析。结果两组患者动脉血气分析指标无明显差别，但是R组pHi在控制性降压后1h、2h明显降低（P〈0．05），PgCO2在控制性降压后1h、2h明显升高（P〈0．05，P〈0．01），w组患者术后肛门排气、排便时间明显短于H组。结论在同样控制性降压幅度下输注万汶和贺斯可改善胃粘膜的灌注，促进术后胃肠功能的恢复。

The Effect of the Different Fluid Infusion During Controlled Hypotension on Gastric Intramucosal pH and the Postoperative Gastroenterological Function

Objective To investigate the effects of the different fluid infusion combined with controlled hypotension on gastric intramucosal pH and the postoperative gastroenterological function in patients undergoing liver surgery. Methods 45 patients（ASA Ⅱ ） scheduled for ectomy of hepatocarcinoma undergoing controlled hypotension, were randomly assigned to three groups and received infusion of 20ml·kg^-1 Ringer＇ s solution（R group）,6% HES（H group） or 6% Voluven group（V group） during 1 hour after induction,respectively. Introgastric PgCO2 and pHi were measured at lh and 2h after controlled hypotension and lh after terminated controlled hypotension using a Tonocap monitor. Meanwhile, artery blood gas analysis,HCT and Hb were also observed. Results There was no obvious different in blood gas indexes among three groups. The significant increased Phi and decreased PgCO2 were produced at lh and 2h after controlled hypotension（P〈 0.05,compared with R group） in H group and V group. The time of anus exhausting and defecating after operation was short in H group than in W group. Conclusion Infusion of HES and Voluven during controlled hypotension could improve the gastroenterological blood flow and thus accelerate recovery of postoperative gastroenterological function.