肾上腺素α1受体激动剂对妇科腹腔镜手术患者乳酸林格氏液的液体动力学影响  

Effect of adrenergic alpha-1 receptor agonists on the volume kinetics of lactated Ringer's solution in patients during laproscopic gynecological surgery

作　　者：单跃 郑晓铸[2] 茹国美[1] 李玉红[1,3] 

机构地区：[1]绍兴市人民医院麻醉科,浙江绍兴312000 [2]浙江医院麻醉科,杭州310022 [3]绍兴市人民医院绍兴市医学研究中心,浙江绍兴312000

出　　处：《中华危重症医学杂志（电子版）》2015年第2期11-17,共7页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省科技厅钱江人才计划项目(2012R10033);浙江省卫生厅课题项目(2014KYB277)

摘　　要：目的探讨小剂量α-肾上腺素受体激动剂(苯氧肾上腺素)对全身麻醉下妇科腹腔镜手术患者乳酸林格氏液的液体动力学的影响。方法将40例妇科腹腔镜手术患者分为两组:对照组(C组)和苯氧肾上腺素组(P组),每组各20例。所有患者在30 min内输入20 ml/kg的乳酸林格氏液,P组患者给予0.01μg·kg-1·min-1持续输注3 h,C组以相同速度输注生理盐水。持续监测患者心率、平均动脉压,并计算累计尿量及尿液生成速率。采用Matlab 4.2软件包,通过血红蛋白计算输入液体后30、60、120及180 min的血浆稀释度,并对患者的液体动力学参数进行评估。结果两组患者的心率均呈下降趋势,但两组比较差异没有统计学意义(Z=-0.639,P=0.523)。非手术期间,P组患者的平均动脉压明显高于C组(Z=-2.491,P=0.020),而手术期间两组比较差异没有统计学意义(Z=-1.571,P=0.235)。P组患者在非手术期间累积尿量和尿液生成速率均高于C组(Z=-2.456、-2.978,P=0.013、0.002),但是两组患者手术期间的累积尿量和尿液生成速率比较,差异没有统计学意义(Z=-1.143、-1.558,P=0.253、0.127)。在输入液体后180 min,P组患者的血浆稀释度低于C组(Z=-2.691,P=0.007)。与C组比较,P组清除速率常数(k10)明显升高(Z=-2.312,P=0.020),而和中央室到外周室转运速率常数(k12)和外周室到中央室两组转运速率常数(k21)明显降低(Z=-0.870、-2.313,P=0.004、0.020)。结论小剂量苯氧肾上腺素可减缓妇科腹腔镜手术患者乳酸林格氏液体从血浆向组织间液转移,同时又可以促进液体从尿液排泄,因此苯氧肾上腺素既可以提高液体治疗的效率,同时减少对肾功能损伤的风险。Objective To evaluate the low dose of adrenergic alpha-1 receptor agonists （phenylephine） on the volume kinetics of lactated Ringer＇s solution in patients undergoing gynecologic surgery under general anesthesia. Methods This was a prospective randomized double-blinded study. Forty patients scheduled for laparoscopic gynecological surgery were randomized into 2 groups： Group C （control group） and Group P （phenylephrine group）, 20 patients in each group. All patients received 20 ml/kg of lactated Ringer＇s solution within 30 min. The patients in Group P were given a continuous infusion of phenylephrine at a rate of0.01 μg·kg^-1·min^-1 3 hours, while the patients in Group C received normal saline with the same speed infusion instead. The heart rates and mean arterial pressure were continuously detected, and the cumulative urine and urine formation rates were calculated. The Matlab 4.2 was used to evaluate the kinetics of Ringer＇s solution and plasma dilution at 30, 60, 120, 180 rain after lactated Ringer＇s solution input. Results The heart rates were falling in the two groups, but there was no significant differences between the two groups （Z=-0.639, P= 0.523）. The mean arterial pressure （Z=-2.491, P = 0.020）, cumulative urine （Z =-2.456, P= 0.013） and urine formation rates （Z=-2.978, P = 0.002） in Group P were higher than those in Group C during non-surgical period, while above indices during non-surgical period all showed no significant differences between the two groups （Z=-1.571, P=0.235; Z=-1.143, P=0.253; Z=-1.558, P= 0.127）. At 180 rain after lactated Ringer＇s solution input, the plasma dilution in Group P was lower than that in Group C （Z=-2.691, P= 0.007）. Compared with Group C, the elimination rate constant （kin） in Group P increased significantly （Z=-2.312, P= 0.020）, the transfer rate constant from central space to peripheral space （k12） and the transfer rate constant from peripheral space to central space （k21） decreased conspicuously （

关 键 词：肾上腺素α1受体激动剂 乳酸林格氏液 液体动力学 腹腔镜 

分 类 号：R614[医药卫生—麻醉学]