CAJ | 학술논문

目的探讨亚甲蓝对感染性休克患者术中氧代谢的影响.方法行急诊手术的感染性休克患者40例,ASA分级Ⅱ或Ⅲ级,年龄38～64岁,体重48～75 kg,随机分为2组(n=20):去甲肾上腺素组(NE组)和亚甲蓝组(MB组).人室后NE组静脉输注去甲肾上腺素0.5～2.0μg·kg-1·min-1至术毕,MB组静脉输注亚甲蓝0.5～1.0 mg·kg-1·h-1至术毕.静脉注射咪达唑仑-依托咪酯-舒芬太尼-维库溴铵麻醉诱导,经口气管插管行机械通气,术中吸入七氟醚,间断静脉注射维库溴铵和舒芬太尼维持麻醉.于麻醉诱导前(T0)、手术开始前(T1)、手术开始后30 min(T2)、60 min(T3)、90 min(T4)及术毕时(T5)记录HR、SvO2、MAP、CVP、每搏量,计算外周血管阻力指数(SVRI)、CI.于上述时点采集桡动脉和颈内静脉血样行血气分析,并测定动脉血乳酸(Lac)浓度,计算氧供指数(DO2I)、氧耗指数(VO2I)和氧摄取率(ERO2).结果与NE组比较,MB组MAP、HR、CVP、SVRI、DO2I、VO2I和ERO2升高,CI和Lac降低(P＜0.05).与T0时比较,T2～5时MB组MAP、HR、CVP、SVRI、VO2I、DO2I和ERO2升高,CI和Lac降低,NE组CI和Lac降低,SVRI、VO2I和ERO2升高(P＜0.05),DO2I差异无统计学意义(P＞0.05).结论术中应用0.5～1.0 mg·kg-1·h-1亚甲蓝不仅可改善感染性休克患者术中血液动力学,还可改善机体氧代谢.
목적 탐토아갑람대감염성휴극환자술중양대사적영향.방법 행급진수술적감염성휴극환자40례,ASA분급Ⅱ혹Ⅲ급,년령38～64세,체중48～75 kg,수궤분위2조(n=20):거갑신상선소조(NE조)화아갑람조(MB조).인실후NE조정맥수주거갑신상선소0.5～2.0μg·kg-1·min-1지술필,MB조정맥수주아갑람0.5～1.0 mg·kg-1·h-1지술필.정맥주사미체서륜-의탁미지-서분태니-유고추안마취유도,경구기관삽관행궤계통기,술중흡입칠불미,간단정맥주사유고추안화서분태니유지마취.우마취유도전(T0)、수술개시전(T1)、수술개시후30 min(T2)、60 min(T3)、90 min(T4)급술필시(T5)기록HR、SvO2、MAP、CVP、매박량,계산외주혈관조력지수(SVRI)、CI.우상술시점채집뇨동맥화경내정맥혈양행혈기분석,병측정동맥혈유산(Lac)농도,계산양공지수(DO2I)、양모지수(VO2I)화양섭취솔(ERO2).결과 여NE조비교,MB조MAP、HR、CVP、SVRI、DO2I、VO2I화ERO2승고,CI화Lac강저(P＜0.05).여T0시비교,T2～5시MB조MAP、HR、CVP、SVRI、VO2I、DO2I화ERO2승고,CI화Lac강저,NE조CI화Lac강저,SVRI、VO2I화ERO2승고(P＜0.05),DO2I차이무통계학의의(P＞0.05).결론술중응용0.5～1.0 mg·kg-1·h-1아갑람불부가개선감염성휴극환자술중혈액동역학,환가개선궤체양대사.
Objective To investigate the effect of methylene blue (MB) on oxygen metabolism in patients with septic shock. Methods Forty ASA Ⅱ or Ⅲ patients with septic shock aged 38-64 yr weighing 48-75 kg undergoing emergency surgery were randomly divided into 2 groups ( n = 20 each): group Ⅰ norepinephrine (group NE) and group Ⅱ MB. The patients were unpremedicated. Anesthesia was induced with midazolam, etomidate,sufentanil and vecuronium and maintained with inhalation of 0.5％-1.5％ sevoflurane and intermittent iv boluses of sufentanil and vecuronium. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 35-45 mm Hg. During operation MB was infused at 0.5-1.0 mg·kg-1·h-1 in group MB and NE at 0.5-2.0 μg· kg-1 · min-1 in group NE respectively to maintain hemodynamic stability. Radial artery was cannulated and connected with Vigileo cardiac output monitor. Right internal jugular vein was cannulated for CVP monitoring.HR, SvO2, MAP, CVP, SV and CI were continuously monitored. Arterial and central venous blood samples were collected simultaneously before induction of anesthesia (T0, baseline), immediately before (T1) and at 30, 60 and 90 min after skin incision (T2-4) and at the end of operation (T5) . Blood gas analysis was performed. O2 consumption index (VO2I), O2 delivery index (DO2I) and O2 extraction rate (ERO2) were calculated. Blood lactate concentration was measured. Results MAP, HR, CVP, SVRI, DO2I, VO2I and ERO2 were significantly higher,while CI and blood lactate concentration lower during operation (T2-5) in group MB than in group NE. MAP, HR,CVP, SVRI, VO2I, DO2I, and ERO2 were significantly higher, while CI and blood lactate concentration were lower during operation (T2-5) as compared with the baseline values at T0 in group MB. In group NE there were no significant change in MAP, HR, CVP and DO2I during operation (T2-5 ) as compared with the baseline at T0. Conclusion Intravenous infusion of MB at 0.5-1.0 mg·kg-1·h-1 during operation may improve hemodynamics and oxygen metabolism in patients with septic shock.