输注预热液体在全凭静脉麻醉下老年患者的临床观察  

The clinical observation of infusing pre - warmed fluids in elder patients during total intravenous anesthesia

作　　者：胡光俊[1] 宋晓阳[1] 陶军[1] 王焱林[2] 

机构地区：[1]广州军区武汉总医院麻醉科,430070 [2]武汉大学中南医院

出　　处：《临床外科杂志》2011年第11期793-795,共3页Journal of Clinical Surgery

摘　　要：目的观察输注预热胶体及晶体液对行全凭静脉麻醉下结肠手术患者体温、顺阿曲库铵（Cis）代谢和苏醒时间的影响。方法36例老年患者择期全凭静脉麻醉下行结肠手术，随机分为A、B两组，每组18例。A组术中输注预热至40℃的万汶和乳酸林格氏液；B组输注室温液体。所有患者入室后输注万汶5ml／kg后行全身麻醉，再输注万汶5ml／kg后切皮，切皮后再输注万汶直到共1000ml。根据出血量输注乳酸林格氏液和万汶。记录入室时、麻醉开始、切皮时及切皮后30、60、90及120min的鼻咽温度。记录各组患者停全麻药至呼之睁眼时间（苏醒时间）及寒颤发生率。采用四个成串（TOF）刺激模式监测Cis肌松效果。记录两组患者停肌松药后TOF值从0恢复到25％（临床作用时间）、75％和90％（体内作用时间）的时间以及25％～75％的时间（恢复指数）。结果麻醉后A组切皮后各点鼻咽温度明显高于B组（P〈0．05）；A组患者苏醒时间短于B组（P〈0．05），寒颤发生率明显少于B组（P〈0．05），Cis临床作用时间和体内作用时间均短于B组（P〈0．05）。结论输注预热液体能有效地提高全凭静脉麻醉下老年患者的鼻咽温度，减少苏醒时间和Cis的残留，同时减少寒颤的发生率。Objective To investigate the effect of pre - warmed crystalloid and colloid solution on body temperature, metabolism of Cisatracurium （Cis） and the time of awaking from general anesthesia （ GA ） in elder patients undergoing colon surgery during total intravenous anesthesia. Methods fifty ASAI - Ⅲ eider patients undergoing colon surgery were randomly divided into group A and group B during GA. Patients in group A（ n = 18）received pre- warmed Voluven（ hydroxyethyl starch 130/0.4 and sodium chloride injection）, followed by pre - warmed crystalloid （ acetate Ringer＇s solution, kept in warmed storage maintained at 40℃ ）during surgery. Patients in group B（ n = 18）received room temperature fluids. All patients received 5 mL/kg Voluven before GA followed by another 5 ml/kg before incision. After completion of 1,000 ml Voluven, acetate Ringer＇s solution was infused. The nasopharyngeal temperature were recorded before and after administration of GA, at incision, and at 30,60,90 and 120 minutes after incision. The time of awaking from GA and the rate of shivering was also recorded. Neuromuscular function was assessed using a accelerometer with train - of - four（TOF） stimulation, the maximum depression of T1 and times of T1 recovered to 25% （the clinic time） ,75% ,90% （the vivo time）were noted. Results In group A, nasopharyngeal temperature was significantly higher after GA, the time of awaking from GA was significantly shorter, the rate of shivering was significantly lower and the clinic time and the vivo time of Cis was shorter （ P 〈 0.05 ）. Conclusion Administration of pre - warmed fluids could raise nasopharyngeal temperature, reduce the time of awaking from GA and the Cis induced neuromuscular block, decrease the rate of shivering in the elder patients.

关 键 词：麻醉 体温 胶体 晶体 老年 

分 类 号：R614[医药卫生—麻醉学]