限制性输液对新生儿腹腔镜十二指肠梗阻手术血流动力学和气管拔管时间的影响分析  

The effect analysis of restricted infusion on hemodynamics and tracheal extubation time in neonates undergoing laparoscopic duodenal obstruction surgery

作　　者：贺牡丹[1] 黄彩霞 李永乐[1] 黄伟坚[1] 胡祖荣[1] 黎昆伟[1] HE Mu-dan;HUANG Cai-xia;LI Yong-le(Department of Anesthesiology,Guangdong Women and Children's Hospital,Guangzhou 510010,China)

机构地区：[1]广东省妇幼保健院,510010

出　　处：《中国实用医药》2022年第15期12-16,共5页China Practical Medicine

基　　金：广州市科技计划项目(项目编号:201904010460)。

摘　　要：目的 探讨限制性输液对新生儿腹腔镜十二指肠梗阻手术血流动力学及气管拔管时间的影响。方法 52 例实施择期腹腔镜十二指肠梗阻手术的新生儿,随机分为常规液体组 (C 组 ) 和限制性液体组 (X 组 ),每组 26 例。C 组术中给予常规补液,X 组术中给予限制性补液。比较两组围术期[麻醉前 (T_(1))、手术切皮时 (T_(2))、手术开始后 1 h(T_(3))、术后 (T_(4))]血流动力学指标[心率 (HR)、平均动脉压 (MAP)、心输出量 (CO)、心脏指数 (CI)、每搏输出量 (SV)、每搏输出量变异率 (SVV)、全身血管阻力 (SVR)],围术期中心静脉血气分析指标[酸碱度 (pH) 值、乳酸、中心静脉血氧饱和度 (ScvO_(2))、血红蛋白 (Hb)、血糖、钠离子 (Na^(+))、钾离子 (K^(+))、钙离子 (Ca^(2+))],术中液体出入量及用药情况,术中麻醉药 ( 舒芬太尼、七氟烷、顺式阿曲库铵 ) 用量和术后气管拔管时间。结果 X 组 T_(3)、T_(4)时 CO 低于 C 组、SVV 高于 C组,T_(4)时 SV 低于 C 组,差异具有统计学意义 (P<0.05)。两组 T_(2)、T_(3)、T_(4)时 CO、CI、SV,T_(4)时 MAP,T_(2)时 SVR,T_(3)、T_(4)时 SVV 均低于本组 T_(1)时,差异具有统计学意义 (P<0.05)。两组各时点的乳酸、ScvO_(2)、Na^(+)、K^(+)、Ca^(2+)比较差异均无统计学意义 (P>0.05);X 组 T_(2)、T_(3)、T_(4)时 pH 值显著高于 C 组,T_(3)、T_(4)时Hb 显著高于 C 组,T_(4)时血糖低于 C 组,差异具有统计学意义 (P<0.05)。X 组术中多巴胺用量 (2389.59±588.99)μg 多于 C 组的 (2061.46±366.42)μg,晶体输注量 (76.68±12.17)ml 和尿量 (11.59±5.88)ml 均少于C 组的 (143.23±22.08)、(17.05±8.20)ml,差异具有统计学意义 (P<0.05);但两组术中 10% 糖补充量、出血量比较差异均无统计学意义 (P>0.05)。两组术中舒芬太尼、七氟烷、顺式阿曲库铵用量比较差异均无统计学意义 (P>0.05);但 X 组术后气管拔管时间 (808.77±327.97)h 短于 C 组的 (1047.68±388.62)h,差异�Objective To discuss the effect of restricted infusion on hemodynamics and tracheal extubation time in neonates undergoing laparoscopic duodenal obstruction surgery.Methods A total of 52 neonates who underwent elective laparoscopic duodenal obstruction surgery were randomly divided into conventional fluid group(group C)and restricted fluid group(group X),with 26 cases in each group.Group C received conventional fluid infusion during surgery,and group X received restricted infusion during surgery.Both groups were compared in terms of hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP),cardiac output(CO),cardiac index(CI),stroke volume(SV),stroke volume variability(SVV),systemic vascular resistance(SVR)]at perioperative period[before anesthesia(T_(1)),during skin incision(T_(2)),1 h after surgery(T_(3)),after surgery(T_(4))],perioperative central venous blood gas analysis indicators[pH value,lactate,central venous oxygen saturation(ScvO_(2)),hemoglobin(Hb),blood glucose,sodium ion(Na^(+)),potassium ion(K^(+)),calcium ion(Ca^(2+))],intraoperative fluid input and medication,intraoperative anesthetics(sufentanil,sevoflurane,cisatracurium)consumption and postoperative tracheal extubation time.Results At T_(3) and T_(4),group X had lower CO than that of group C,and higher SVV than that of group C;at T_(4),group X had lower SV than that of group C.All the differences were statistically significant(P<0.05).The CO,CI,SV at T_(2),T_(3),and T_(4),MAP at T_(4),SVR at T_(2),and SVV at T_(3) and T_(4) in the two groups were all lower than those at T_(1) in this group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in lactate,ScvO_(2),Na_(+),K_(+),Ca^(2+) between the two groups at each time point(P>0.05).The pH value of group X at T_(2),T_(3) and T_(4) was significantly higher than that of group C,the Hb value at T_(3) and T_(4) was significantly higher than that of group C,and the blood glucose at T_(4) was lower than that of group C.All the differences

关 键 词：腹腔镜十二指肠梗阻手术 新生儿 血流动力学 限制性输液 中心静脉血氧饱和度 

分 类 号：R722.1[医药卫生—儿科]