摘要
目的评价诱导期超容量液体填充对老年胃肠道肿瘤患者术中血流动力学的影响。方法选取2017年10月-2018年3月在上海交通大学医学院附属瑞金医院择期行腹腔镜下胃或结直肠肿瘤手术的老年患者51例,年龄60~85岁,随机分为两组:常规输液组(对照组,26例),诱导期超容量液体填充组(试验组,25例)。对照组按常规方法补液;试验组于麻醉诱导前30 min开始予10 mL/kg的乳酸钠林格液补充生理需要量,全身麻醉诱导开始后30 min内予12 mL/kg的琥珀酰明胶(Gel)进行超容量液体填充,术中失血量以等容量的Gel补充。若收缩压(SBP)降低幅度超过基础值的30%且持续3 min以上,静脉推注麻黄素5 mg/次。于入手术室休息5 min后(T0)、麻醉诱导后5 min(T1)、建立人工气腹前(T2)、气腹后5 min(T3)、气腹后30 min(T4)、开腹后5 min(T5)和关闭腹腔(T6)时,记录患者无创血流动力学指标、动脉血压变异率(PPV),自T2时间点开始记录中心静脉压(CVP),并于入手术室吸空气时和关闭腹腔时采集桡动脉血进行血气分析;记录患者术中总输液量和尿量,术中麻黄素使用量和次数,术后首次排气时间和术后住院时间。结果两组间患者一般情况、手术时间、麻醉时间、气腹时间、术中出血量的差异均无统计学意义(P值均>0.05),试验组术中总输液量、晶体输入量、胶体输入量和术中尿量均显著多于对照组(P值均<0.05);试验组术中使用麻黄素次数和使用量均显著低于对照组(P值均<0.05);试验组T1至T5时间点的PPV分别显著低于对照组同时间点(P值均<0.05),T2至T4时间点的CVP、平均动脉压分别显著高于对照组同时间点(P值均<0.05),T2时间点的每搏输出量(SV)显著高于对照组同时间点(P<0.05)、心率显著慢于对照组同时间点(P<0.05)。试验组T2至T6时间点和对照组T1至T4时间点的心输出量(CO)均显著低于同组T0时间点(P值均<0.05),试验组T3至T6时间点和对照组T1至T4时间点SV均显著低于同组T0时间点(P值均<0.05),两组T3时间点的外周血管阻力(SVR)均显著高于同组T0时间点(P值均<0.05)。试验组T3至T5时间点和对照组T5、T6时间点PPV均显著低于同组T1时间点(P值均<0.05)。两组T3至T6时间点的CVP均显著高于同组T2时间点(P值均<0.05)。结论诱导期超容量液体填充能够减少术中低血压的发生,减少血管活性药物的使用,维持良好的肾脏灌注,使循环和血流动力学状态更加稳定。
Objective To evaluate the effect of hypervolemic fluid infusion during induction of general anesthesia on hemodynamics in elderly patients undergoing laproscopic gastrointestinal surgery.Methods Fifty-one patients who were aged 60-85 years old and underwent elective laproscopic gastrointestinal surgery between October 2017 and March 2018 in our hospital were enrolled in this randomized controlled trial.All the patients were randomly divided into control group(n=26)and experimental group(n=25).In the control group,fluid was given routinely.In the experimental group,lactated Ringer’s solution(RL,10 mL/kg)was infused intravenously 30 min before anesthesia,then succinylated gelatin(Gel,12 mL/kg)was given within 30 min after induction of anesthesia.Intraoperative blood loss was replaced with the equal volume of Gel.Ephedrine(5 mg)was injected intravenously once systolic pressure decreased by more than 30%of the base for value over 3 min.Noninvasive hemodynamic parameters and pulse pressure variation(PPV)were recorded 5 min after entering the operating room(T0),5 min after induction(T1),before CO2 pneumoperitoneum(T2),5 min(T3)and 30 min(T4)after pneumoperitoneum,5 min after incision(T5),and when suturing peritoneum(T6).The central venous pressure(CVP)was recorded at the beginning of catheterization of central venous catheter after induction.The arterial blood gas analysis was performed at the time of air inhalation and suturing peritoneum.Fluid balance,the usage and frequency of ephedrine injection,the time of first exhausting and postoperative hospital stay were also recorded.Results There was no significant difference in general information,surgical time,anesthetic time,pneumoperitoneum time or the volume of blood loss between the two groups(all P>0.05).The volume of total fluid as well as crystalloid and colloid transfusion and urine volume during operation in the experimental group were significantly higher than those in the control group(all P<0.05).However,the total usage and frequency of ephedrine injection in the experimental group were significantly less than those in the control group(both P<0.05).In test group PPV at T1 to T5 were significantly lower than those in control group(all P<0.05);CVP and MAP at T2 to T4 were significantly higher than those in control group(all P<0.05);stroke volume(SV)at T2 was significantly higher than control(P<0.05),while the heart rate was significantly slower than control(P<0.05).In test group,cardiac output(CO)at T2 to T6,and SV at T3 to T6,were significantly lower than T0 correspondingly(all P<0.05);in control group,CO and SV at T1 to T4 were significantly lower than T0(all P<0.05);systemic vascular resistance(SVR)at T3 in both groups were significantly lower than T0 in the same group(both P<0.05).PPV at T3 to T5 in the test group and T5 to T6 in the control group were significantly lower than T1 in the same group(all P<0.05).CVP at T3 to T6 in both groups were significantly higher than T2 in the same group(all P<0.05).Conclusion Hypervolemic fluid infusion during induction of general anesthesia can reduce the incidence of hypotension and the use of vasoactive agents,maintain optimized renal perfusion and make circulation and hemodynamics more stable.
作者
韩晴晴
罗艳
HAN Qingqing;LUO Yan(Department of Anesthesiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《上海医学》
CAS
北大核心
2020年第2期104-108,共5页
Shanghai Medical Journal
作者简介
通信作者:罗艳,电子邮箱为ly11087@rjh.com.cn
