术中输注氨基酸对胃肠道手术患者脂代谢和体温的影响  

Effect of intraoperative amino acids infusion on the metabolism of fat and body temperature in the patients undergoing gastrointestinal surgery

作　　者：钟静[1] 葛圣金[1] 庄小凤[1] 仓静[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200032

出　　处：《复旦学报（医学版）》2010年第4期437-441,446,共6页Fudan University Journal of Medical Sciences

摘　　要：目的研究术中静脉输注氨基酸对在硬膜外阻滞复合全麻下行胃肠道手术患者脂肪代谢和体温的影响。方法选择择期行胃肠道手术患者32例,ASAⅠ~Ⅱ级,随机分成两组（n=16）：分别在麻醉诱导同时输注18-氨基酸混合液4 KJ.kg-1.h-1（即2 mL.kg-1.h-1,AA组）和乳酸钠林格氏液2 mL.kg-1.h-1（LR组）直至手术结束。监测麻醉前30 min,诱导后手术开始前,手术开始后30 min、2 h,手术结束后30 min、2 h的鼻咽温度,血清胆固醇、三酰甘油、游离脂肪酸（free fatty acid,FFA）浓度和血酮体的变化。结果两组术中鼻咽温度均呈下降趋势,但AA组手术开始后2 h鼻咽温度显著高于LR组（P〈0.05）,手术结束后两组温度有所回升,AA组手术结束后2 h鼻咽温度[（36.89±0.13）℃]较麻醉前30 min[（36.98±0.13）℃]差异无统计学意义（P〉0.05）,且显著高于LR组[（36.10±0.15）℃]（P〈0.05）,LR组仍显著低于麻醉前30 min[（37.04±0.15）℃]（P〈0.05）;两组术中血清胆固醇浓度均呈下降趋势,手术开始后30 min至手术结束后2 h浓度较麻醉前30 min显著降低（P〈0.05）,而两组间差异无统计学意义（P〉0.05）;诱导后手术开始前两组的血清三酰甘油浓度均较术前显著升高（P〈0.05）,LR组手术结束后2 h浓度[（0.71±0.27）mmol/L]较麻醉前30 min[（0.99±0.38）mmol/L]显著降低（P〈0.05）,而在AA组差异无统计学意义（P〉0.05）;两组手术开始后30 min2、h血清FFA浓度均显著低于麻醉前30 min（P〈0.05）,且AA组[（0.52±0.15,0.42±0.09）mmol/L]显著低于LR组[（0.81±0.24,0.82±0.22）mmol/L,P〈0.05],而手术结束后2 h浓度AA组[（1.04±0.28）mmol/L]显著高于LR组[（0.82±0.16）mmol/L,P〈0.05];两组围术期各时间点血酮体均为阴性。结论术中输注氨基酸可减少硬膜外阻滞复合全麻下行胃肠道手术患者体温的降低,并抑制脂肪动员。Objective To study the effect of intraoperative amino acids infusion on the fat metabolism and body temperature in the patients undergoing gastrointestinal surgery under general anesthesia combined with epidural block. Methods Thirty-two patients scheduled for gastrointestinal surgery were randomly assigned to receive either compound amino acid injection（18AA-Ⅱ）（group AA） or lactated Ringer＇s solution（group LR） at a rate of 4 KJ·kg-1·h-1（2 mL·kg-1·h-1） from the induction of anesthesia to the end of surgery.Nasopharyngeal core temperatures were measured,and serum cholesterol,triglyceride,free fatty acid（FFA） and ketone bodies were analyzed before,during and after the surgery. Results Nasopharyngeal temperature declined during the surgery in both groups,however,the temperatures at 2 hours after the beginning of surgery in AA group were significantly higher than those in LR group（P0.05）.Nasopharyngeal temperatures rebounded after the surgery.The temperature at 2 hours after the surgery in AA group [（36.89±0.13） ℃] was significantly higher than that in LR group [（36.10±0.15） ℃]（P0.05）,which significantly decreased compared with 30 minutes before anesthesia [（37.04±0.15） ℃]（P0.05）.Compared with 30 minutes before anesthesia,serum cholesterol concentrations significantly decreased from 30 minutes to 2 hours after the surgery in both groups（P0.05）,while there was no statistical difference between the two groups（P0.05）.Compared with 30 minutes before anesthesia,serum triglyceride concentrations after the induction of anesthesia were significantly higher in both groups（P0.05） and significantly decreased at 2 hours after the surgery in LR group（P0.05）,however,it did not change significantly in AA group（P0.05）.Serum FFA concentrations at 30 minutes and 2 hours after the beginning of surgery in AA group [（0.52±0.15,0.42±0.09）mmol/L] were significantly lower than those in LR group [（0.81±0.24,0.82±0.22）mmol/L,P0.05].Meanwhile,serum FFA

关 键 词：氨基酸 体温 脂代谢 硬膜外麻醉 全身麻醉 胃肠道手术 

分 类 号：R459.3[医药卫生—治疗学]