限制性输液复合小剂量去甲肾上腺素对胃肠道手术老年患者脑氧代谢的影响  

Effects of fluid restriction in combination with small dose of norepinephrine on cerebral oxygen metabolism in elderly patients undergoing gastrointestinal surgery

作　　者：邱晓东[1] 居斌华 叶卉[1] 陆新健[1] 景亮[1] 汤文浩[2] 

机构地区：[1]东南大学附属中大医院麻醉科,南京市210009 [2]东南大学附属中大医院普外科,南京市210009

出　　处：《中华麻醉学杂志》2015年第6期656-659,共4页Chinese Journal of Anesthesiology

基　　金：江苏省卫生厅重点项目（H201337）

摘　　要：目的评价限制性输液复合小剂量去甲。肾上腺素对胃肠道手术老年患者脑氧代谢的影响。方法择期行胃或结直肠切除术的老年患者40例，年龄65～80岁，性别不限，BMI 18～24kg／m^2，ASA分级Ⅰ或Ⅱ级，心功能分级Ⅰ或Ⅱ级，左心室射血分数≥50％，采用随机数字表法，将其分为2组（n=20）：常规输液组（S组）和限制性输液复合小剂量去甲肾上腺素组（RN组）。S组按常规方法补液，术中静脉注射麻黄碱5mg／次，维持MAP≥65mmHg；RN组麻醉诱导前30min开始以5ml·kg^-1·h^-1的速率静脉输注乳酸钠林格氏液，麻醉诱导后静脉输注去甲肾上腺素0．01～0．03μg·kg^-1·min^-1，维持MAP≥65mmHg。术中失血量以等容量6％羟乙基淀粉130／0．4氯化钠注射液补充。分别于切皮前5min、切皮后1h、2h和出麻醉恢复室时，采集颈内静脉球部血样及桡动脉血样行血气分析，计算动脉血氧含量、颈静脉球血氧含量、动脉-颈静脉球血氧含量差、脑氧摄取率和脑血流／脑氧代谢率比值。结果2组各时点动脉血氧含量、颈静脉球血氧含量、动脉-颈静脉球血氧含量差、脑氧摄取率和脑血流／脑氧代谢率比值比较差异无统计学意义（P〉0．05）。结论限制性输液复合小剂量去甲肾上腺素对胃肠道手术老年患者脑氧代谢无影响。Objective To evaluate the effects of fluid restriction in combination with small dose of norepinephrine on cerebral oxygen metabolism in elderly patients undergoing gastrointestinal surgery. Methods Forty elderly patients of both sexes, aged 65-80 yr, with body mass index of 18-24 kg/m^2 , of ASA physical status Ⅰ or Ⅱ（NYHA Ⅰor Ⅱ ） , with left ventricular ejection fraction≥50%, undergoing elective gastrointestinal surgery, were randomly divided into 2 groups （n = 20 each ） using a random number table： routine fluid administration group （group S） and restricted fluid administration ＋ small dose of norepinephrine group （group RN）. In group S, lactated Ringer＇s solution was given routinely, ephedrine 5 mg （per time） was injected intravenously, and MAP was maintained ≥ 65 mmHg during operation. In group RN, lactated Ringer＇s solution was infused intravenously at 5 ml · kg^-1 · h^-1 starting from 30 min before anesthesia, norepinephrine was infused intravenously at 0.01-0.03 μg · kg^-1 · min^-1 after induction of anesthesia, and MAP was maintained≥ 65 mmHg. Intraoperative blood loss was replaced with the equal volume of 6% hydroxyethyl starch 130/0.4 sodium chloride injection in both groups. At 5 min before skin incision, 1 and 2 h after skin incision and postanesthesia care unit discharge time, arterial and jugular bulb venous blood samples were obtained for blood gas analysis, and arterial oxygen content, jugularbulb venous oxygen content, arteriovenous oxygen content difference, cerebral oxygen extraction rate, and the ratio of cerebral blood flow to cerebral oxygen metabolic rate were calculated. Results There were no significant differences between the two groups in arterial oxygen content, jugular bulb venous oxygen content, arteriovenous oxygen content difference, cerebral oxygen extraction rate, and the ratio of cerebral blood flow to cerebral oxygen metabolic rate. Conclusion Fluid restriction combined with small dose of norepinephrine produces no effects on cer

关 键 词：补液疗法 去甲肾上腺素 氧耗量 脑 老年人 

分 类 号：R614[医药卫生—麻醉学]