异氟烷麻醉下妇科手术期间静脉滴注乳酸钠林格液的液体动力学特点  

Volume kinetics of lactated Ringer's solution during isoflurane anaesthesia in patients undergoing gynecologic surgery

作　　者：杜园园[1] 于布为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,200025

出　　处：《上海医学》2009年第1期11-18,共8页Shanghai Medical Journal

基　　金：上海市自然科学基金资助项目(03ZR14046)

摘　　要：目的观察异氟烷麻醉下行妇科手术期间静脉滴注乳酸钠林格液的液体动力学特点,并比较呋塞米、多巴胺对其的影响。方法36例择期行全身麻醉下妇科手术的患者随机均分为组Ⅰ、组Ⅱ、组Ⅲ。3组麻醉诱导后均使用异氟烷维持麻醉,最低肺泡有效浓度(MAC)维持于1.0,并予乳酸钠林格液25mL/kg,1h内匀速静脉滴注;组Ⅱ同时采用微泵静脉注射呋塞米0.1mg·kg-1.h-1×1h,组Ⅲ予静脉注射多巴胺2μg·kg-1.min-1×1h。将血红蛋白作为血浆稀释度的检测指标,并记录整个麻醉手术期间血液动力学指标、胸阻抗、动脉血氧分压、血电解质、血清醛固酮、尿β2-微球蛋白(β2-MG)和尿肌酐(Cr)的动态变化。结果组Ⅰ的液体清除速率常数(kr)仅为7.4mL/min。随补液的进行,组I胸阻抗值逐渐减小,血清醛固酮、尿β2-MG/Cr校正值逐渐增加,手术开始后与基础值的差异有统计学意义(P值均<0.05)。组Ⅱ、Ⅲ的液体排泄率、胸阻抗值均较组Ⅰ显著增加(P值均<0.05),血管外液体转移量显著减小(P<0.05);但3组间血浆稀释曲线、液体潴留率的差异均无统计学意义(P值均>0.05)。组Ⅱ术后尿β2-MG/Cr校正值均显著低于组Ⅰ、组Ⅲ(P值均<0.05)。结论麻醉期间尿液排泄减少,手术操作使液体倾向于在组织间隙潴留,从而造成血管外肺水增加和肾小管功能损伤。利尿剂可在不影响血浆扩容量的情况下增加尿液排泄,改善组织水肿。而小剂量多巴胺静脉注射不具有保护肾功能的作用。Objective To investigate the characteristics of volume kinetics of lactated Ringer＇s solution during isoflurane anaesthesia in patients undergoing gynecologic surgery in the presence or absence of two diuretics： furosemide and ＂renal dose＂ dopamine. Methods A bolus infusion of 25 mL/kg lactated Ringer＇s solution over 1 hour just after the induction were given to patients with American Society of Anesthesiologists （ASA） Ⅰ or Ⅱ （aged 23-65 years） and who were receive elective gynecologic surgeries. The patients were randomly assigned to 3 groups： control group （n = 12）, furosemide group （1 mg·kg^-1· h^-1, n = 12） and dopamine group （2 μg·kg^-1 ·min^-1, n = 12）. The anaesthesia was maintained by inhalation of 1.0 MAC isoflurane. Plasma dilution curve was fitted to concentration of hemoglobin. Hemoclynamic values and transthoracic electrical bioimpedances （ TEB ） were monitored. Arterial oxygen pressures, serum electrolytes, aldosterone, urinary β2-microglobu- line （β2-MG） and creatinine （Cr） were measured at baseline and during the anaesthetic-operative period. Results Patients characteristics, hemodynamics, arterial oxygen pressures, concentrations of serum sodium and aldosterone were similar among the 3 groups. Volume kinetic analysis showed a decreased urinary excretion and an increased extravascular fluid accumulation during the anaesthetic-operative period in control group, with the clea- rance constant of elimination k, averaged at 7.4 mL/min and the half-time of infused fluid in the body being 15 times longer than that in the blood vessel. The TEB decreased, surum aldosterone and urinary β2-MG increased significantly during the infusion, especially after the beginning of the surgery in control group （all P〈0.05）. The use of the 2 diuretics significantly increased the urinary excretion and TEB, decreased the extravascular fluid translocation （all P〈0.05 vs. control group）. Plasma dilution and intravascular fluid retention remained unchanged

关 键 词：液体动力学 血浆稀释度 异氟烷麻醉 乳酸钠林格液 经胸生物电阻抗 尿Β2-微球蛋白 

分 类 号：R614[医药卫生—麻醉学] R977.7[医药卫生—外科学]