术中输注氨基酸对硬膜外阻滞复合全麻开胸手术患者围术期体温的影响  

Effect of amino acid infusion on perioperative body temperature in patients undergoing thoracotomy under combined epidural-general anesthesia

作　　者：费敏[1] 诸杜明[1] 葛圣金[1] 薛张纲[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海市200032

出　　处：《中华麻醉学杂志》2006年第12期1061-1064,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价术中输注氨基酸对硬膜外阻滞复合全麻食管癌和贲门癌手术患者围术期深部体温和代谢的影响。方法择期食管癌和贲门癌手术患者21例,ASAⅠ或Ⅱ级,随机分为3组(n =7):从麻醉诱导开始至手术结束,分别静脉输注氨基酸混合液240kJ·h-1(AA组)、等容量乳酸钠林格氏液(LR组)、葡萄糖溶液240kJ·h-1(GLU组)。麻醉诱导前至术后2h每5分钟测定鼓膜温度,于麻醉诱导前即刻、手术开始后1h和术后1h检测指尖血糖,采用4分表法评价术后2h内寒战的发生情况,采用间接测热仪测定术前与术后氧耗。结果与麻醉诱导前即刻比较,术后30min LR组和GLU组氧耗降低,AA组氧耗升高(P<0.01),术后2h LR组、GLU组鼓膜温度降低(P<0.05),AA组差异无统计学意义(P>0.05);与LR组和GLU组比较,AA组术后2h内寒战发生例数减少(P< 0.05),术后30min氧耗增多(P<0.05),LR组与GLU组比较差异无统计学意义(P>0.05)。结论硬膜外阻滞复合全麻开胸手术患者术中静脉输注氨基酸可通过提高基础代谢率,缓解围术期深部体温降低,减少术后寒战发生,而输注葡萄糖不产生此效应。Objective To investigate the effect of intraoperative amino acid infusion on core temperature and metabolism in patients undergoing elective thoracic surgery under combined epidural-general anesthesia. Methods Twenty-one ASA Ⅰ or Ⅱ patients （17 male, 4 female） aged 38-67 yes undergoing elective esophagus or eardia cancer operation under combined epidural-general anesthesia were randomly divided into 3 groups （ n = 7 each） ： group Ⅰ received intravenous infusion of mixed amino acids at a rate of 240 k J·h^-1 from induction of anesthesia to the end of operation （AA）; group Ⅱ received infusion of equal volume of lactated Ringer＇s solution （LR） and group Ⅲ received infusion of glucose with calorie equal to that in AA group （GLU）. Core temperature was monitored at tympanic membrane from induction of anesthesia to 2 h after operation. Blood glucose was measured before induction of anesthesia, at 1 h after operation was started and 2 h after operation. Shivering was evaluated by 4-point scale （0 = no shivering, 1 = slight or intermittent shivering, 2 = moderate shivering, 3 = sustained severe shivering）. Oxygen consumption was measured and recorded by indirect calorimetry before and after operation. Results In LR group core temperature was significantly decreased at 2 h after operation as compared to the baseline before induction of anesthesia and the incidence of shivering was significantly higher than in AA group. In AA group oxygen consumption was significantly higher than in LR and GLU groups. In GLU group core temperature was significantly decreased at 2 h after operation as in group LR and blood glucose level was significantly higher at 1 h after start of operation than in AA and LR groups, Conclusions Intraoperative infusion of amino acids can effectively reduce the incidence of shivering after operation by maintaining a higher metabolic rate, but glucose infusion can not,

关 键 词：氨基酸类 胸廓切开术 体温调节 麻醉 全身 麻醉 硬膜外 

分 类 号：R614[医药卫生—麻醉学]