小剂量去甲肾上腺素联合目标导向液体治疗对颅内肿瘤切除术患者脑氧代谢的影响  

Effect of low-dose norepinephrine combined with goal-directed fluid therapy on cerebral oxygen metabolism in patients undergoing intracranial tumor resection

作　　者：周瑞玲 张志强[1] 边庆虎[1] 李艳丽[1] 孟利江 张山[1] Zhou Ruilirig;Zhang Zhiqiang;Bian Qinghu;Li Yanli;Meng Lijiang;Zhang Shan(Department of Anesthesiology,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院麻醉科,石家庄市050000

出　　处：《中华麻醉学杂志》2018年第11期1358-1361,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价小剂量去甲肾上腺素联合目标导向液体治疗对颅内肿瘤切除术患者血流动力学及脑氧代谢的影响。方法择期颅内肿瘤切除术患者40例,年龄≥18岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=20):目标导向液体治疗组(G组)和小剂量去甲肾上腺素联合目标导向液体治疗组(N组)。2组均以每搏量变异度(SVV)为目标导向进行补液,当SVV≤13%时,以1~2ml·kg^-1·h^-1的速度补液;当SVV>13%超过5min时,加速补液,使其降至13%以下。N组在麻醉诱导后通过中心静脉持续泵注去甲肾上腺素0.01~0.03μg·kg^-1·min^-1,维持MAP≥65mmHg。在麻醉诱导后(T1)、打开硬脑膜时(T2)、开硬脑膜1h(T3)和术毕(T4)时记录HR和MAP,采集颈内静脉球部血样和桡动脉血样行血气分析。记录术中液体出入量。计算动脉血氧含量(CaO2)、颈静脉球血氧含量(CjvO2)、动脉-颈静脉球血氧含量差(Ca-jvO2)、脑氧摄取率(CERO2)、脑血流/脑氧代谢率比值(CBF/CMRO2比值)和脑乳酸生成率(LacPR)。结果与G组相比,N组T4时MAP和T3,4时CERO2升高,总液体量和晶体液量降低(P<0.05),CaO2、CjvO2、Ca-jvO2、CBF/CMRO2比值和LacPR差异无统计学意义(P>0.05)。结论小剂量去甲肾上腺素联合目标导向液体治疗应用于颅内肿瘤切除术患者可减少术中输液量,改善脑氧供。Objective To evaluate the effect of low-dose norepinephrine(NE)combined with goal-directed fluid therapy(GDFT)on cerebral oxygen metabolism in patients undergoing intracranial tumor resection.Methods Forty patients of American Society of Anesthesiologists physical statusⅡor Ⅲ,aged≥18 yr,scheduled for elective intracranial tumor resection,were divided into 2 groups(n=20 each)using a random number table method:GDFT group(group G)and low-dose NE combined with GDFT group(group N).Fluid was replaced according to stroke volume variation(SVV)under the guidance of Flotrac-Vigileo system in both groups.When SVV≤13%,fluid was replaced at 1-2 ml·kg^-1·h^-1.When SVV>13% for more than 5 min,fluid replacement was enhanced to reduce it below 13%.In group N,NE was infused continuously via the central vein at 0.01-0.03 μg·kg^-1·min^-1 after anesthesia induction,and mean arterial pressure(MAP)was maintained≥65 mmHg.After anesthesia induction(T1),when the dura of brain was opened(T2),at 1 h after opening the dura(T3)and at the end of surgery(T4),the heart rate and MAP were recorded,and blood samples were collected from the internal jugular venous bulb and radial artery for blood gas analysis.The fluid input and output were recorded.Arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,cerebral oxygen extraction rate,cerebral lactic acid production rate and ratio of cerebral blood flow to cerebral oxygen metabolic rate were calculated.Results Compared with group G,MAP at T4 and cerebral oxygen extraction rate at T3,4 were significantly increased,the total volume of fluid and volume of crystalloid solution were decreased(P<0.05),and no significant change was found in arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,ratio of cerebral blood flow to cerebral oxygen metabolic rate or cerebral lactic acid production rate in group N(P>0.05).Conclusion Low-dose NE combined with GDFT can reduce the intraoperative volume of fluid infu

关 键 词：脑肿瘤 颅骨切开术 去甲肾上腺素 补液疗法 每搏输出量 氧耗量 脑 

分 类 号：R614[医药卫生—麻醉学]