中华危重症医学杂志（电子版）
中華危重癥醫學雜誌（電子版）
중화위중증의학잡지（전자판）
CHINESE JOURNAL OF CRITICAL CARE MEDICINE ( ELECTRONIC EDITON)
2015年
2期
84-91
,共8页
单跃%郑晓铸%茹国美%李玉红
單躍%鄭曉鑄%茹國美%李玉紅
단약%정효주%여국미%리옥홍
肾上腺素α1受体激动剂%乳酸林格氏液%液体动力学%腹腔镜
腎上腺素α1受體激動劑%乳痠林格氏液%液體動力學%腹腔鏡
신상선소α1수체격동제%유산림격씨액%액체동역학%복강경
Adrenergic alpha-1 receptor agonists%Ringer's lactate solution%Volume kinetics%Laparoscopic
目的：探讨小剂量α-肾上腺素受体激动剂（苯氧肾上腺素）对全身麻醉下妇科腹腔镜手术患者乳酸林格氏液的液体动力学的影响。方法将40例妇科腹腔镜手术患者分为两组：对照组（C组）和苯氧肾上腺素组（P组），每组各20例。所有患者在30 min内输入20 ml/kg的乳酸林格氏液，P组患者给予0.01μg·kg-1·min-1持续输注3 h，C组以相同速度输注生理盐水。持续监测患者心率、平均动脉压，并计算累计尿量及尿液生成速率。采用Matlab 4.2软件包，通过血红蛋白计算输入液体后30、60、120及180 min 的血浆稀释度，并对患者的液体动力学参数进行评估。结果两组患者的心率均呈下降趋势，但两组比较差异没有统计学意义（Z =-0.639，P =0.523）。非手术期间，P组患者的平均动脉压明显高于C组（Z=-2.491，P=0.020），而手术期间两组比较差异没有统计学意义（Z=-1.571，P=0.235）。P组患者在非手术期间累积尿量和尿液生成速率均高于C组（Z=-2.456、-2.978，P=0.013、0.002），但是两组患者手术期间的累积尿量和尿液生成速率比较，差异没有统计学意义（Z =-1.143、-1.558，P =0.253、0.127）。在输入液体后180 min，P组患者的血浆稀释度低于C组（Z =-2.691，P =0.007）。与C组比较，P组清除速率常数（k10）明显升高（Z =-2.312，P =0.020），而和中央室到外周室转运速率常数（k12）和外周室到中央室两组转运速率常数（k 21）明显降低（Z=-0.870、-2.313，P=0.004、0.020）。结论小剂量苯氧肾上腺素可减缓妇科腹腔镜手术患者乳酸林格氏液体从血浆向组织间液转移，同时又可以促进液体从尿液排泄，因此苯氧肾上腺素既可以提高液体治疗的效率，同时减少对肾功能损伤的风险。
目的：探討小劑量α-腎上腺素受體激動劑（苯氧腎上腺素）對全身痳醉下婦科腹腔鏡手術患者乳痠林格氏液的液體動力學的影響。方法將40例婦科腹腔鏡手術患者分為兩組：對照組（C組）和苯氧腎上腺素組（P組），每組各20例。所有患者在30 min內輸入20 ml/kg的乳痠林格氏液，P組患者給予0.01μg·kg-1·min-1持續輸註3 h，C組以相同速度輸註生理鹽水。持續鑑測患者心率、平均動脈壓，併計算纍計尿量及尿液生成速率。採用Matlab 4.2軟件包，通過血紅蛋白計算輸入液體後30、60、120及180 min 的血漿稀釋度，併對患者的液體動力學參數進行評估。結果兩組患者的心率均呈下降趨勢，但兩組比較差異沒有統計學意義（Z =-0.639，P =0.523）。非手術期間，P組患者的平均動脈壓明顯高于C組（Z=-2.491，P=0.020），而手術期間兩組比較差異沒有統計學意義（Z=-1.571，P=0.235）。P組患者在非手術期間纍積尿量和尿液生成速率均高于C組（Z=-2.456、-2.978，P=0.013、0.002），但是兩組患者手術期間的纍積尿量和尿液生成速率比較，差異沒有統計學意義（Z =-1.143、-1.558，P =0.253、0.127）。在輸入液體後180 min，P組患者的血漿稀釋度低于C組（Z =-2.691，P =0.007）。與C組比較，P組清除速率常數（k10）明顯升高（Z =-2.312，P =0.020），而和中央室到外週室轉運速率常數（k12）和外週室到中央室兩組轉運速率常數（k 21）明顯降低（Z=-0.870、-2.313，P=0.004、0.020）。結論小劑量苯氧腎上腺素可減緩婦科腹腔鏡手術患者乳痠林格氏液體從血漿嚮組織間液轉移，同時又可以促進液體從尿液排洩，因此苯氧腎上腺素既可以提高液體治療的效率，同時減少對腎功能損傷的風險。
목적：탐토소제량α-신상선소수체격동제（분양신상선소）대전신마취하부과복강경수술환자유산림격씨액적액체동역학적영향。방법장40례부과복강경수술환자분위량조：대조조（C조）화분양신상선소조（P조），매조각20례。소유환자재30 min내수입20 ml/kg적유산림격씨액，P조환자급여0.01μg·kg-1·min-1지속수주3 h，C조이상동속도수주생리염수。지속감측환자심솔、평균동맥압，병계산루계뇨량급뇨액생성속솔。채용Matlab 4.2연건포，통과혈홍단백계산수입액체후30、60、120급180 min 적혈장희석도，병대환자적액체동역학삼수진행평고。결과량조환자적심솔균정하강추세，단량조비교차이몰유통계학의의（Z =-0.639，P =0.523）。비수술기간，P조환자적평균동맥압명현고우C조（Z=-2.491，P=0.020），이수술기간량조비교차이몰유통계학의의（Z=-1.571，P=0.235）。P조환자재비수술기간루적뇨량화뇨액생성속솔균고우C조（Z=-2.456、-2.978，P=0.013、0.002），단시량조환자수술기간적루적뇨량화뇨액생성속솔비교，차이몰유통계학의의（Z =-1.143、-1.558，P =0.253、0.127）。재수입액체후180 min，P조환자적혈장희석도저우C조（Z =-2.691，P =0.007）。여C조비교，P조청제속솔상수（k10）명현승고（Z =-2.312，P =0.020），이화중앙실도외주실전운속솔상수（k12）화외주실도중앙실량조전운속솔상수（k 21）명현강저（Z=-0.870、-2.313，P=0.004、0.020）。결론소제량분양신상선소가감완부과복강경수술환자유산림격씨액체종혈장향조직간액전이，동시우가이촉진액체종뇨액배설，인차분양신상선소기가이제고액체치료적효솔，동시감소대신공능손상적풍험。
Objective To evaluate the low dose of adrenergic alpha-1 receptor agonists (phenylephine) on the volume kinetics of lactated Ringer's solution in patients undergoing gynecologic surgery under general anesthesia. Methods This was a prospective randomized double-blinded study. Forty patients scheduled for laparoscopic gynecological surgery were randomized into 2 groups: Group C (control group) and Group P (phenylephrine group), 20 patients in each group. All patients received 20 ml/kg of lactated Ringer's solution within 30 min. The patients in Group P were given a continuous infusion of phenylephrine at a rate of 0.01μg·kg-1·min-1 3 hours, while the patients in Group C received normal saline with the same speed infusion instead. The heart rates and mean arterial pressure were continuously detected, and the cumulative urine and urine formation rates were calculated. The Matlab 4.2 was used to evaluate the kinetics of Ringer's solution and plasma dilution at 30, 60, 120, 180 min after lactated Ringer's solution input. Results The heart rates were falling in the two groups, but there was no significant differences between the two groups (Z=-0.639, P=0.523). The mean arterial pressure (Z=-2.491, P=0.020), cumulative urine (Z=-2.456, P=0.013) and urine formation rates (Z=-2.978, P=0.002) in Group P were higher than those in Group C during non-surgical period, while above indices during non-surgical period all showed no significant differences between the two groups (Z=-1.571, P=0.235; Z=-1.143, P=0.253; Z=-1.558, P=0.127). At 180 min after lactated Ringer's solution input, the plasma dilution in Group P was lower than that in Group C (Z=-2.691, P=0.007). Compared with Group C, the elimination rate constant (k10) in Group P increased significantly (Z=-2.312, P=0.020), the transfer rate constant from central space to peripheral space (k12) and the transfer rate constant from peripheral space to central space (k21) decreased conspicuously (Z=-0.870, -2.313, P=0.004, 0.020). Conclusion Low dose of phenylephrine can both slow down the distribution of fluid from the plasma to the interstitial fluid space and promote urine excretion, thereby improving efficiency of fluid treatment and reducing the risk of kidney injury.
