CAJ | 학술논문

目的评价限制性输液复合小剂量去甲肾上腺素对胃肠道手术老年患者脑氧代谢的影响.方法择期行胃或结直肠切除术的老年患者40例,年龄65 ～ 80岁,性别不限,BMI 18 ～ 24kg/m2,ASA分级Ⅰ或Ⅱ级,心功能分级Ⅰ或Ⅱ级,左心室射血分数≥50％,采用随机数字表法,将其分为2组(n=20):常规输液组(S组)和限制性输液复合小剂量去甲肾上腺素组(RN组).S组按常规方法补液,术中静脉注射麻黄碱5 mg/次,维持MAP≥65 mmHg;RN组麻醉诱导前30 min开始以5ml· kg-1·h-1的速率静脉输注乳酸钠林格氏液,麻醉诱导后静脉输注去甲肾上腺素0.01 ～0.03μg·kg-1 ·min-1,维持MAP≥65 mmHg.术中失血量以等容量6％羟乙基淀粉130/0.4氯化钠注射液补充.分别于切皮前5 min、切皮后lh、2h和出麻醉恢复室时,采集颈内静脉球部血样及桡动脉血样行血气分析,计算动脉血氧含量、颈静脉球血氧含量、动脉-颈静脉球血氧含量差、脑氧摄取率和脑血流/脑氧代谢率比值.结果 2组各时点动脉血氧含量、颈静脉球血氧含量、动脉-颈静脉球血氧含量差、脑氧摄取率和脑血流/脑氧代谢率比值比较差异无统计学意义(P＞0.05).结论限制性输液复合小剂量去甲肾上腺素对胃肠道手术老年患者脑氧代谢无影响.
목적 평개한제성수액복합소제량거갑신상선소대위장도수술노년환자뇌양대사적영향.방법 택기행위혹결직장절제술적노년환자40례,년령65 ～ 80세,성별불한,BMI 18 ～ 24kg/m2,ASA분급Ⅰ혹Ⅱ급,심공능분급Ⅰ혹Ⅱ급,좌심실사혈분수≥50％,채용수궤수자표법,장기분위2조(n=20):상규수액조(S조)화한제성수액복합소제량거갑신상선소조(RN조).S조안상규방법보액,술중정맥주사마황감5 mg/차,유지MAP≥65 mmHg;RN조마취유도전30 min개시이5ml· kg-1·h-1적속솔정맥수주유산납림격씨액,마취유도후정맥수주거갑신상선소0.01 ～0.03μg·kg-1 ·min-1,유지MAP≥65 mmHg.술중실혈량이등용량6％간을기정분130/0.4록화납주사액보충.분별우절피전5 min、절피후lh、2h화출마취회복실시,채집경내정맥구부혈양급뇨동맥혈양행혈기분석,계산동맥혈양함량、경정맥구혈양함량、동맥-경정맥구혈양함량차、뇌양섭취솔화뇌혈류/뇌양대사솔비치.결과 2조각시점동맥혈양함량、경정맥구혈양함량、동맥-경정맥구혈양함량차、뇌양섭취솔화뇌혈류/뇌양대사솔비치비교차이무통계학의의(P＞0.05).결론 한제성수액복합소제량거갑신상선소대위장도수술노년환자뇌양대사무영향.
Objective To evaluate the effects of fluid restriction in combination with small dose of norepinephrine on cerebral oxygen metabolism in elderly patients undergoing gastrointestinal surgery.Methods Forty elderly patients of both sexes,aged 65-80 yr,with body mass index of 18-24 kg/m2,of ASA physical status Ⅰ or Ⅱ (NYHA Ⅰ or Ⅱ),with left ventricular ejection fraction≥50％,undergoing elective gastrointestinal surgery,were randomly divided into 2 groups (n =20 each) using a random number table:routine fluid administration group (group S) and restricted fluid administration + small dose of norepinephrine group (group RN).In group S,lactated Ringer's solution was given routinely,ephedrine 5 mg (per time) was injected intravenously,and MAP was maintained ≥ 65 mmHg during operation.In group RN,lactated Ringer's solution was infused intravenously at 5 ml · kg-1 · h-1 starting from 30 min before anesthesia,norepinephrine was infused intravenously at 0.01-0.03 μg · kg-1 · min-1 after induction of anesthesia,and MAP was maintained ≥ 65 mmHg.Intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl starch 130/0.4 sodium chloride injection in both groups.At 5 min before skin incision,1 and 2 h after skin incision and postanesthesia care unit discharge time,arterial and jugular bulb venous blood samples were obtained for blood gas analysis,and arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,cerebral oxygen extraction rate,and the ratio of cerebral blood flow to cerebral oxygen metabolic rate were calculated.Results There were no significant differences between the two groups in arterial oxygen content,jugular bulb venous oxygen content,arteriovenous oxygen content difference,cerebral oxygen extraction rate,and the ratio of cerebral blood flow to cerebral oxygen metabolic rate.Conclusion Fluid restriction combined with small dose of norepinephrine produces no effects on cerebral oxygen metabolism in elderly patients undergoing gastrointestinal surgery.