中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
21期
1463-1466
,共4页
余微萍%胡俊%李金兰%温宏
餘微萍%鬍俊%李金蘭%溫宏
여미평%호준%리금란%온굉
关节成形术,置换,髋%E选择素%参附汤
關節成形術,置換,髖%E選擇素%參附湯
관절성형술,치환,관%E선택소%삼부탕
Arthroplasty,replacement,hip%E-selectin%SHENFU decoction
目的 探讨参附注射液对行全髋关节置换术的老年患者术中血流动力学和血浆E-选择素浓度的影响.方法 择期行全髋关节置换术老年患者24例,按随机数字表随机分为参附注射液组(S组)与生理盐水对照组(N组),每组12例.术前两组患者一般情况差异无统计学意义.S组:麻醉成功后予参附注射液0.2 ml/kg经外周静脉缓慢注射,继以0.8 ml·kg-1·h-1持续注入至手术结束;N组则以生理盐水替代.术后均予患者自控镇痛(PCEA).检测术前(T0)、手术结束即刻(T3)及术后24 h(T4)血浆E-选择素浓度.分别记录T0、术后15 min(T1)、术后30 min(T2)、T3各时间点心率、平均动脉压和中心静脉压.结果 两组患者手术时间、术中输液差异无统计学意义;两组血流动力学差异均无统计学意义(均P＞0.05);S组各时间点血浆E-选择素浓度差异均无统计学意义(均P＞0.05),N组在T3、T4时明显升高[(119±23)mg/L、(109±23)mg/L],与T0比较差异有统计学意义[(86±15)mg/L,P＜0.01],与S组比较明显高[T0、T3、T4分别为(92±37)、(83±15)、(83±12)mg/L,P＜0.05或0.01].结论 行全髋关节置换术的老年患者围术期血浆E-选择素浓度明显升高,参附注射液可以抑制其升高,抑制血管内皮细胞的活化,对血流动力学无明显的影响.
目的 探討參附註射液對行全髖關節置換術的老年患者術中血流動力學和血漿E-選擇素濃度的影響.方法 擇期行全髖關節置換術老年患者24例,按隨機數字錶隨機分為參附註射液組(S組)與生理鹽水對照組(N組),每組12例.術前兩組患者一般情況差異無統計學意義.S組:痳醉成功後予參附註射液0.2 ml/kg經外週靜脈緩慢註射,繼以0.8 ml·kg-1·h-1持續註入至手術結束;N組則以生理鹽水替代.術後均予患者自控鎮痛(PCEA).檢測術前(T0)、手術結束即刻(T3)及術後24 h(T4)血漿E-選擇素濃度.分彆記錄T0、術後15 min(T1)、術後30 min(T2)、T3各時間點心率、平均動脈壓和中心靜脈壓.結果 兩組患者手術時間、術中輸液差異無統計學意義;兩組血流動力學差異均無統計學意義(均P＞0.05);S組各時間點血漿E-選擇素濃度差異均無統計學意義(均P＞0.05),N組在T3、T4時明顯升高[(119±23)mg/L、(109±23)mg/L],與T0比較差異有統計學意義[(86±15)mg/L,P＜0.01],與S組比較明顯高[T0、T3、T4分彆為(92±37)、(83±15)、(83±12)mg/L,P＜0.05或0.01].結論 行全髖關節置換術的老年患者圍術期血漿E-選擇素濃度明顯升高,參附註射液可以抑製其升高,抑製血管內皮細胞的活化,對血流動力學無明顯的影響.
목적 탐토삼부주사액대행전관관절치환술적노년환자술중혈류동역학화혈장E-선택소농도적영향.방법 택기행전관관절치환술노년환자24례,안수궤수자표수궤분위삼부주사액조(S조)여생리염수대조조(N조),매조12례.술전량조환자일반정황차이무통계학의의.S조:마취성공후여삼부주사액0.2 ml/kg경외주정맥완만주사,계이0.8 ml·kg-1·h-1지속주입지수술결속;N조칙이생리염수체대.술후균여환자자공진통(PCEA).검측술전(T0)、수술결속즉각(T3)급술후24 h(T4)혈장E-선택소농도.분별기록T0、술후15 min(T1)、술후30 min(T2)、T3각시간점심솔、평균동맥압화중심정맥압.결과 량조환자수술시간、술중수액차이무통계학의의;량조혈류동역학차이균무통계학의의(균P＞0.05);S조각시간점혈장E-선택소농도차이균무통계학의의(균P＞0.05),N조재T3、T4시명현승고[(119±23)mg/L、(109±23)mg/L],여T0비교차이유통계학의의[(86±15)mg/L,P＜0.01],여S조비교명현고[T0、T3、T4분별위(92±37)、(83±15)、(83±12)mg/L,P＜0.05혹0.01].결론 행전관관절치환술적노년환자위술기혈장E-선택소농도명현승고,삼부주사액가이억제기승고,억제혈관내피세포적활화,대혈류동역학무명현적영향.
Objective To investigate the effects of Shenfu (SF) injection on hemodynamics and plasma E-selectin concentrations in elderly patients undergoing total hip replacement (THR). Methods A total of 24 ASA Ⅱ/Ⅲ patients aged 65 to 85 years old were divided equally into two groups (n = 12). In Group S, SF injection was administered by peripheral intravenous infusion at initially 0. 2 ml/kg and then patients received a post-operative regimen of patient-controlled epidural analgesia (PCEA). Blood samples were taken pre-operation ( T0), immediately post-operation (T3) and 24 hours post-operation (T4) so as to detect the levels of E-selectin at these time points.mean arterial pressure (MAP) , heart rate (HR) and central venous pressure (CVP) were continuously monitored and recorded at T0, 15 min post-anesthesia (T1 ), 30 min post-anesthesia (T2) and T3. Results The concentrations of E-selectin in Group N increased at T3 and T4 while those decreased in Group S [(119 ± 23 ) mg/L and(109 ± 23) mg/L vs (86 ±15)mg/L,(83 ±15)mg/L and (83 ±12)mg/L vs(92 ±37)mg/ L, all P＜0. 01]. As compared with Group S, they were significantly higher in Group N (P ＜ 0. 05 or 0. 01). There was no significant difference in CVP, HR and MAP between two groups. Conclusion The activation of vascular endothelial cells is manifested by an elevated plasma concentration of E-selectin in the elderly patients undergoing THR. SF injection can inhibit the activation and exert no significant effects on the hemodynamics.
