血液稀释联合硝酸甘油对腹腔镜亲属捐肾者全身氧合的影响  

Effects of hemodilution combined nitroglycerin on systemic oxygenation in relative donor undergoing laparoscopic nephrectomy

作　　者：刘秀娟[1] 崔华庆[1] 

机构地区：[1]中国石化集团胜利石油管理局胜利医院,山东东营257055

出　　处：《腹腔镜外科杂志》2013年第5期395-399,共5页Journal of Laparoscopic Surgery

摘　　要：目的:观察血液稀释联合硝酸甘油对腹腔镜亲属捐肾者全身氧合的影响。方法:选择行气腹腹腔镜肾脏切除术的健康亲属捐肾者30例,随机分为实验组(S组,n=15)与对照组(C组,n=15)。麻醉诱导前15 min至肾动脉阻断时两组连续输注4%琥珀酰明胶(MFG)及乳酸林格氏液(LR)(MFG∶LR=1∶1),目标血液稀释值红细胞压积(HCT)为35%。S组同时应用微量泵输注硝酸甘油,初始量为1.5～2μg.kg-.1min-1,维持平均动脉压(MAP)在基础值±25%之内。两组呼气末二氧化碳分压(PETCO2)维持在35～40 mmHg;CO2气腹压力维持在10～13 mmHg。于诱导前(T0)、麻醉平稳后10 min(T1)、气腹时(T2)、气腹后30 min(T3)、肾动脉阻断时(T4)及手术结束时(T5)测定两组患者SaO2、HCT、CO、Lac、胃黏膜PgCO2及血气分析、血流动力学参数等,计算DO2、VO2、Pg-aCO2的变化,并记录术毕液体出入量、麻醉时间、手术时间、液体灌注时间及术中麻醉药物、硝酸甘油用量等。结果:两组液体出入量、麻醉时间、手术时间、液体灌注时间、术中麻醉药物及不同时间点HCT、VO2等指标差异无统计学意义(P>0.05)。与T0相比,两组供肾者T2～T4时MAP、HR显著升高(P<0.05);T2时两组DO2、CO均降低,T4时均升高(P<0.05);C组供肾者T2、T3时Lac、Pg-aCO2有升高趋势(P<0.05)。与C组相比,S组T2～T4时MAP、HR、CVP显著降低,T2、T4时DO2、CO升高明显,T2、T3时Lac、Pg-aCO2降低(P<0.05)。结论:气腹腹腔镜肾脏切除术中行轻度血液稀释联合硝酸甘油,对亲属捐肾者安全性较高,而且其全身氧代谢稳定,内脏氧合良好,未见启动无氧代谢状态。Objective：To investigate the effects of hemodilution combined nitroglycerin on systemic oxygenation in relative donor undergoing laparoseopie nephrectomy. Methods ： Thirty healthy donors, aged 19-55 y, weighing 42-62 kg, scheduled for laparoscopie nephreetomy under pneumoperitoneum,were randomly divided into 2 groups：experimental group （group S,n = 15 ） and eontrol group （ group C ,n = 15 ）. Two groups were performed with modified 4% fluid gelatin （MFG） and Laetated Ringerg solution （LR） （ MFG： LR = 1：1 ） infusion from 15 rain before anesthesia induction to stopping renal artery, goal hemoerit （HCT） was 35 %. In group S, nitroglycerin was transfused by micro pump at the dosage of 1.5-2 μg·kg^-1· min^-1 at beginning, to maintain mean arterial pressure （MAP） in the basic value plus or minus 25% range. In both groups, end-expiratory pressure of carbon dioxide was maintained in 35-40 mmHg range, and CO2 inflation pressure was 10-13 mmHg. HCT, CO, SaO2, OO2, go2, Lac, PgCO2, Pg-aCO2 and hemodynamies parameters, blood gas analysis data were measured and reeorded before anesthesia induction （To ）, 10 min after anesthesia （T1 ）, at the pneumoperitoneum beginning （ T2 ） , after 30 rain （ T3 ） , during blocking renal artery （ T4 ） and at end of operation （ T5 ）. Liquid quantity, anesthesia time, operation time, liquid filling time and intraoperative anesthetic drugs, nitroglyeerin consumption, etc, were recorded at T5. Results ： There was no significant difference in liquid quantity, anesthesia time, operation time, liquid filling time, intraoperative anesthetic drugs and HCT,VO2 at different time points （P 〉 0.05）. MAP and HR were higher at T2-T4, 002 and CO were lower at T2 and higher at T4 in both groups than that at To （ P 〈 0.05 ）. Lae and Pg-aCO2 gradually rose at T2-T3 in group C （ P 〈 0.05 ）. Compared with group C, MAP,HR and CVP were lower at T24, DO2 and CO were higher at T2, T4, Lac and Pg-aCO2 were lower at T2-T3 in group S （

关 键 词：血液稀释 硝酸甘油 腹腔镜检查 供肾者 氧代谢 胃黏膜Pg-aCO2值 

分 类 号：R614[医药卫生—麻醉学]