不同剂量甲氧明联合限制性输液对老年胸腔镜肺叶切除术的影响  

Effects of different doses of methoxamine combined with restricted fluid infusion in elderly patients undergoing thoracoscopic lobectomy

作　　者：李吉梅 向梅 易强林 莫怀忠 LI Ji-mei;XIANG Mei;YI Qiang-lin;MO Huai-zhong(College of Anesthesiology,Guizhou Medical University,Guiyang Guizhou 550004,China;Department of Anesthesiology,Guizhou Provincial People's Hospital,Guiyang Guizhou 550000,China;Department of Anesthesiology,Affiliated Hospital of Guizhou Medical University,Guiyang Guizhou 550004,China;Department of Anesthesiology,Affiliated Oncology Hospital of Guizhou Medical University,Guiyang Guizhou 550004,China)

机构地区：[1]贵州医科大学麻醉学院,贵州贵阳550004 [2]贵州省人民医院麻醉科,贵州贵阳550000 [3]贵州医科大学附属医院麻醉科,贵州贵阳550004 [4]贵州医科大学附属肿瘤医院麻醉科,贵州贵阳550004

出　　处：《局解手术学杂志》2024年第12期1057-1061,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：贵州省卫生健康委员会基金(2021XMSB000332352)。

摘　　要：目的 分析不同剂量甲氧明联合限制性输液对老年胸腔镜肺叶切除术的影响。方法 纳入拟行胸腔镜肺叶切除术的老年患者 120 例,按随机数字表法分为对照组(C 组)、2 μg·kg^(-1)·min^(-1)甲氧明组(M_(1)组)、3 μ·kg^(-1)·min^(-1)甲氧明组(M_(2)组)和4 μg·kg^(-1)·min^(-1)甲氧明组(M_(3)组)。对比患者麻醉前(T0)、麻醉诱导后(T1)、单肺通气前(T2)、单肺通气 5 min(T3)、肺叶切除后即刻(T4)、单肺通气结束后(T5)、平卧位后(T6)的平均动脉压(MAP)、心率、中心静脉压(CVP)及脉压变异率(PPV)。比较各组患者 T0 和T6时的乳酸值与氧合指数。记录各组患者术中晶体量、胶体量、尿量、失血量。统计术中高血压、低血压、心动过速、心动过缓、肺水肿、低氧血症,以及术后 7 d 内肺部感染、肺不张和急性肾损伤等并发症发生率。结果 与 C 组比较,在 T1 时,M_(2)、M_(3)组患者 MAP 和CVP明显升高(P<0. 05),M_(1)、M_(2)组患者PPV明显降低(P<0. 05),M_(3)组患者心率明显降低(P<0. 05)。T0时C组与其他3组患者的氧合指数和乳酸值无显著差异(P>0. 05),T6时 M_(2)组患者氧合指数明显高于 C 组和 M_(3)组(P<0. 05),T6时 M_(3)组患者乳酸值明显高于 M_(2)组(P<0. 05)。与 C组比较,另 3组患者胶体量和晶体量明显减少(P<0. 05)。与 C组相比,M_(3)组患者术中高血压和心动过缓发生率明显升高(P<0. 05),M_(2)、M_(3)组患者术中低血压发生率明显降低(P<0. 05)。4 组术后并发症发生率比较,差异无统计学意义(P>0. 05)。结论 3 μg·kg^(-1)·min^(-1)甲氧明联合限制性输液应用于老年胸腔镜肺叶切除术中可维持血流动力学稳定,保证良好的组织灌注,是一种可以安全应用于老年患者的循环管理方案。Objective To analyze the effects of different doses of methoxamine combined with restricted fluid infusion in elderly patients undergoing thoracoscopic lobectomy.Methods A total of 120 elderly patients undergoing thoracoscopic lobectomy were included and divided into control group(group C),2μg·kg^(-1)·min^(-1) methoxamine group(M_(1) group),3μg·kg^(-1)·min^(-1) methoxyamine group(M_(2) group)and 4μg·kg^(-1)·min^(-1) methoxamine group(M_(3) group)according to random number table.The mean arterial pressure(MAP),heart rate,central venous pressure(CVP)and pulse pressure variation(PPV)of patients before anesthesia(T0),after anesthesia induction(T1),before one-lung ventilation(T2),after one-lung ventilation for 5 minutes(T3),immediately after lobectomy(T4),after one-lung ventilation(T5)and after supine position(T6)were compared.The lactic acid value and oxygenation index of patients at T0 and T6 in each group were compared.The amount of crystal,colloid,urine and blood loss of patients in each group were recorded.The incidence of complications such as hypertension,hypotension,tachycardia,bradycardia,pulmonary edema and hypoxemia during operation,and pulmonary infection,atelectasis and acute kidney injury within 7 days after operation were counted.Results Compared with group C,MAP and CVP at T1 of patients in M_(2) group and M_(3) group significantly increased(P<0.05),PPV at T1 of patients in M_(1) group and M_(2) group significantly decreased(P<0.05),while heart rate of patients in M_(3) group significantly decreased(P<0.05).There was no significant difference in oxygenation index or lactic acid value at T0 of patients between group C and other groups(P>0.05),oxygenation index at T6 of patients in M_(2) group was significantly higher than those in group C and M_(3) group(P<0.05),lactic acid value at T6 of patients in M_(3) group was significantly higher than that in M_(2) group(P<0.05).Compared with group C,the dosage of colloid and crystal in other three groups significantly decreased(P<0.05).Compared with gro

关 键 词：甲氧明 限制性输液 胸腔镜肺叶切除术 老年 血流动力学 

分 类 号：R614[医药卫生—麻醉学]