中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2009年
2期
147-150
,共4页
林成新%彭永保%张光英%李英英%刘敬臣
林成新%彭永保%張光英%李英英%劉敬臣
림성신%팽영보%장광영%리영영%류경신
降压,控制性%中心静脉压%小肠%氧耗量
降壓,控製性%中心靜脈壓%小腸%氧耗量
강압,공제성%중심정맥압%소장%양모량
Hypotension,controlled%Central venous pressure%Intestine,small%Oxygen consump-tion
目的 评价控制性低中心静脉压(CVP)对肝叶切除术患者小肠氧代谢的影响.方法 全麻下择期行肝叶切除术患者30例,ASA Ⅰ或Ⅱ级,随机分为3组(n=10):正常CVP常规输液组(Ⅰ组)、低CVP限制输液组(Ⅱ组)和低CVP常规输液组(Ⅲ组).Ⅰ组及Ⅲ组麻醉诱导前静脉输注乳酸钠林格氏液8～10 ml/kg,麻醉诱导期间开始静脉输注乳酸钠林格氏液和6%羟乙基淀粉130/0.4(1:1)10～15 ml·kg-1h-1.Ⅱ组麻醉诱导前静脉输注乳酸钠林格氏液1 ml/kg,麻醉诱导期间开始静脉输注乳酸钠林格氏液1 ml·kg-1·h-1,至肝实质完全离断前.Ⅱ组和Ⅲ组开腹前静脉注射呋塞咪10 mg,开腹后静脉输注硝酸甘油0.05～0.8μg·kg-1·min-1,在肝实质开始离断前降低CVP至0～5 cm H2O并维持到肝实质完全离断,肝实质完全离断后停用硝酸甘油并快速静脉输注乳酸钠林格氏液和6%羟乙基淀粉130/0.4,使CVP>6 Cm H2O.分别于开腹后降CVP前(T1)及肝实质完全离断后升高CVP前(T2)取桡动脉血样和肠系膜上静脉血样,进行血气分析,测定乳酸盐浓度,计算动脉血氧含量(CaO2)、静脉血氧含量(CsmvO2)、氧摄取率(ERO2)和肠系膜上静脉-动脉乳酸盐浓度差(Dsmv-aBL).结果 与T1时比较,三组T2时CaO2和CsmvO2均下降(P<0.05),但都在正常范围内,ERO2和Dsmv-aBL差异无统计学意义(P>0.05).三组各时点PaO2、SaO2、CaO2、CsmvO2、ERO2和Dsmv-aBL比较差异无统计学意义(P>0.05).结论 控制性低CVP对肝叶切除术患者小肠氧代谢无不良影响,提示机体的氧供需仍能保持平衡.
目的 評價控製性低中心靜脈壓(CVP)對肝葉切除術患者小腸氧代謝的影響.方法 全痳下擇期行肝葉切除術患者30例,ASA Ⅰ或Ⅱ級,隨機分為3組(n=10):正常CVP常規輸液組(Ⅰ組)、低CVP限製輸液組(Ⅱ組)和低CVP常規輸液組(Ⅲ組).Ⅰ組及Ⅲ組痳醉誘導前靜脈輸註乳痠鈉林格氏液8～10 ml/kg,痳醉誘導期間開始靜脈輸註乳痠鈉林格氏液和6%羥乙基澱粉130/0.4(1:1)10～15 ml·kg-1h-1.Ⅱ組痳醉誘導前靜脈輸註乳痠鈉林格氏液1 ml/kg,痳醉誘導期間開始靜脈輸註乳痠鈉林格氏液1 ml·kg-1·h-1,至肝實質完全離斷前.Ⅱ組和Ⅲ組開腹前靜脈註射呋塞咪10 mg,開腹後靜脈輸註硝痠甘油0.05～0.8μg·kg-1·min-1,在肝實質開始離斷前降低CVP至0～5 cm H2O併維持到肝實質完全離斷,肝實質完全離斷後停用硝痠甘油併快速靜脈輸註乳痠鈉林格氏液和6%羥乙基澱粉130/0.4,使CVP>6 Cm H2O.分彆于開腹後降CVP前(T1)及肝實質完全離斷後升高CVP前(T2)取橈動脈血樣和腸繫膜上靜脈血樣,進行血氣分析,測定乳痠鹽濃度,計算動脈血氧含量(CaO2)、靜脈血氧含量(CsmvO2)、氧攝取率(ERO2)和腸繫膜上靜脈-動脈乳痠鹽濃度差(Dsmv-aBL).結果 與T1時比較,三組T2時CaO2和CsmvO2均下降(P<0.05),但都在正常範圍內,ERO2和Dsmv-aBL差異無統計學意義(P>0.05).三組各時點PaO2、SaO2、CaO2、CsmvO2、ERO2和Dsmv-aBL比較差異無統計學意義(P>0.05).結論 控製性低CVP對肝葉切除術患者小腸氧代謝無不良影響,提示機體的氧供需仍能保持平衡.
목적 평개공제성저중심정맥압(CVP)대간협절제술환자소장양대사적영향.방법 전마하택기행간협절제술환자30례,ASA Ⅰ혹Ⅱ급,수궤분위3조(n=10):정상CVP상규수액조(Ⅰ조)、저CVP한제수액조(Ⅱ조)화저CVP상규수액조(Ⅲ조).Ⅰ조급Ⅲ조마취유도전정맥수주유산납림격씨액8～10 ml/kg,마취유도기간개시정맥수주유산납림격씨액화6%간을기정분130/0.4(1:1)10～15 ml·kg-1h-1.Ⅱ조마취유도전정맥수주유산납림격씨액1 ml/kg,마취유도기간개시정맥수주유산납림격씨액1 ml·kg-1·h-1,지간실질완전리단전.Ⅱ조화Ⅲ조개복전정맥주사부새미10 mg,개복후정맥수주초산감유0.05～0.8μg·kg-1·min-1,재간실질개시리단전강저CVP지0～5 cm H2O병유지도간실질완전리단,간실질완전리단후정용초산감유병쾌속정맥수주유산납림격씨액화6%간을기정분130/0.4,사CVP>6 Cm H2O.분별우개복후강CVP전(T1)급간실질완전리단후승고CVP전(T2)취뇨동맥혈양화장계막상정맥혈양,진행혈기분석,측정유산염농도,계산동맥혈양함량(CaO2)、정맥혈양함량(CsmvO2)、양섭취솔(ERO2)화장계막상정맥-동맥유산염농도차(Dsmv-aBL).결과 여T1시비교,삼조T2시CaO2화CsmvO2균하강(P<0.05),단도재정상범위내,ERO2화Dsmv-aBL차이무통계학의의(P>0.05).삼조각시점PaO2、SaO2、CaO2、CsmvO2、ERO2화Dsmv-aBL비교차이무통계학의의(P>0.05).결론 공제성저CVP대간협절제술환자소장양대사무불량영향,제시궤체적양공수잉능보지평형.
Objective To investigate the effect of controlled low central venous pressure (CVP) on intestinal oxygen metabohsm in patients undergoing hepatic lobectomy.Methods Thirty ASA Ⅰ or Ⅱ patients with fight liver tumor aged 27-60 yr weighing 48-85 kg undergoing elective hepatic lohectomy under general anesthesia were randomly divided into 3 groups (n=10 each) : group Ⅰ normal CVP + conventional fluid administration; group Ⅱ low CVP + restricted fluid administration and group Ⅲ low CVP + conventional fluid administration.The patients were premedicated with intransuscular diazepam 10 mg and atropine 0.5 mg. Anesthesia was induced with midazolam, fentanyl, propofol and vecuronium and maintained with isoflurane inhalation, propofol infusion and intermittent iv boluses of fentanyl and vecuronium. The patients were mechanically ventilated (VT=10 ml/kg,RR= 10-13 bpm). Group Ⅰ and Ⅱ received lactated Ringer's solution (LRS) 8-10 ml/kg before induction of anesthesia and LRS and 6% hydroxyethyl starch (HES) 130/0.4 (in a ratio of 1 : 1) were infused at 10-15 ml·kg-1·h-1 during operation. Group Ⅱ received LRS 1 ml/kg before induction of anesthesia and LRS infused was continued at 1 ml·kg-1·h-1 during the course of operation until the diseased liver parenchyma was removed. In group Ⅱ and Ⅲ CVP was controlled at 0-5 cm H2O by intravenous nitroglycerin infusion after abdomen was opened until the diseased liver parenchyma was removed. Blood samples were obtained from radial artery and superior mesentefic vein (SMV) for blood gas analysis and determination of lactate concentration before CVP was lowered (T1) and at the end of low CVP (T2). Arterial O2 content (CaO2),O2 content of SMV blood (CsmvO2), oxygen extraction ratio (ERO2) and difference in blood lactate between artery and SMV (Dsmv-aBL)were calculated. Results CaO2 and CsmvO2 were significantly decreased at T2 as compared with the baseline before CVP was lowered at T1 in all 3 groups (P < 0.05) but were still within normal range. There was no significant diference in ERO2, Dsmv-aBL, PaO2, SaO2, CaO2 and CsmvO2 at both T, and T2 among the 3 groups. Conclusion Low CVP has no significant adverse effect on intestinal oxygen metabolism in patients undergoing hepatie lobectomy.
