聚明胶肽预扩容对肝切除术病人术中胃黏膜灌注的影响  

Effect of Volume Expansion With Polygeline on Gastric Intramucosal Hypoperfusion in Patients Undergoing Hepatectomy

作　　者：阳兴[1] 黄漫[1] 吴炎豪[1] 卓兆麒[1] 

机构地区：[1]广东省江门市中心医院麻醉科,广东江门529070

出　　处：《南华大学学报（医学版）》2006年第4期534-537,共4页Journal of Nanhua University(Medical Edition)

摘　　要：目的观察聚明胶肽预扩容对硬膜外阻滞复合全麻下肝切除术病人胃黏膜pH(i-pH)和胃黏膜二氧化碳分压(PgCO2)以及PgCO2与PaCO2的差值(PCO2gap)的影响。方法择期拟行肝切除术患者60例,随机分为聚明胶肽组(P组)和复方氯化钠组(R组)。均在硬膜外阻滞复合全麻下手术。分别于诱导后切皮前以聚明胶肽(P组)15 mL/kg或复方氯化钠(R组)15 mL/kg扩容,术中两组均恒速输入聚明胶肽和复方氯化钠。分别于扩容前(T0)、扩容后30 min(T1)、扩容后60 min(T2)及手术结束时(T3)记录动脉pH(pHa)、PaCO2、动脉血乳酸(Lac)、i-pH、PgCO2和PCO2gap。术中同时记录MAP、HR、CVP、出血量、Hb、Hct和尿量。结果i-pH在T2及T3时P组均明显高于R组(P<0.05)。PCO2gap在T2及T3时,P组均明显低于R组(P<0.05)。T3时两组Hct、Hb、pHa及Lac差异无显著性。结论聚明胶肽预扩容对于维持复合麻醉下肝切除术病人术中胃黏膜的灌注优于复方氯化钠组。Objective To investinate the effect of volume expansion with Polygeline on gastric intramucosal pH （i- pH） and the difference between PgCO2 and PaCO2 （PaCO2gap）. Methods Sixty ASA Ⅰ-Ⅱ patients, aged between 35 - 66 years, without any chronic or acute stomach diseases, undergoing Hepatectomy were randomly divided into polygeline group（group P） and Rinner＇ s group（group R）. All patients received combined epidural general anesthesia. Patients received polygeline 15 mL/kg in group P or Rinner＇ s 15 mL/kg in group R before skin incision and received polygeline 4 mL/kg and Rinner＇ s 7 mL/kg during operation. Data of arterial pH（pHa）, arterial CO2 （PaCO2）, arterial lactate acid concentration （Lac）, i - pH, PgCO2, PCO2 gap were recorded before volume expansion （T0）, and at 30 min （T1）, 60 min （T2） after volume expansion and at the end of surgery（ T3 ）. MAP, H R, CVP, blood loss, Hb, Hct, urinary output were monitored and recorded at the same time points. Results At T2 and T3, the i - pH in group P was significantly greater than those in group R（ P 〈 0.05）. PCO2 gap in group P at T2 and T3 was significantly lower than that in group R（P 〈0.05）.There was no sirmificant difference between the two groups at the end of the surgery（T3 ） in terms of Hb. Hepatectomy under combined epidurat general anesthesia improve gastric intramucosal hypoperfusion. Hct, Lac and pHa volume expansion Conclusion with polygeline In patients undergoing before skin incision may improve gastric intramucosal hypoperfusion.

关 键 词：聚明胶肽 血浆容量扩充 胃黏膜灌注 

分 类 号：R657.3[医药卫生—外科学]