本文選題：去氧腎上腺素 + 去甲腎上腺素��； 參考：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的:加速康復外科(Enhanced Recovery After Surgery,ERAS)策略是圍術期安全、有效的管理策略,液體管理作為麻醉管理中影響加速康復外科策略結果的關鍵因素,與患者術后腸道功能的早期恢復及并發(fā)癥的發(fā)生相關。臨床研究表明,限制性輸液能夠改善結直腸手術患者的預后,是符合加速康復外科理念的液體管理策略。限制性輸液時可潛在亞臨床低血壓,影響組織灌注,小劑量去甲腎上腺素在限制性輸液時對組織灌注的改善已得到驗證。作為與去甲腎上腺素藥理學特性相似的臨床常用血管活性藥物,去氧腎上腺素對限制性輸液老年患者組織氧代謝的影響尚缺少相關臨床研究。本研究對去氧腎上腺素對限制性輸液老年患者組織氧代謝的影響進行觀察,為老年患者結直腸道手術的液體管理提供參考。方法:選擇60例擇期行結直腸切除術的老年患者,隨機分為去氧腎上腺素組(A組)和去甲腎上腺素組(B組)。患者入室后給予12m1·kg~(-1)乳酸鈉林格液,繼而以5m1·kg~(-1)·h~(-1)的速度輸注,麻醉誘導后,A組術中給予負荷劑量去氧腎上腺素100μg,繼而靜脈輸注小劑量去氧腎上腺素0.1-0.3μg·kg~(-1)·min~(-1)。B組則給予等效負荷劑量的去甲腎上腺素10μg,繼而以0.01-0.03μg·kg~(-1)·min~(-1)輸注去甲腎上腺素。圍術期維持平均動脈壓(Mean Arterial Pressure,MAP)≥65 mm Hg,以6%羥乙基淀粉130/0.4氯化鈉注射液(Hydroxyethyl Starch Injection,HES)補充術中失血量。分別記錄兩組患者在術前(基礎狀態(tài))、手術開始后1 h、2 h及出麻醉恢復室時4個時間點的MAP、HR和中心靜脈壓(Central Venous Pressure,CVP),同時分別采集動脈血和中心靜脈血的血樣,進行血氣分析。記錄患者Hb、血清白蛋白、尿素(BUN)、肌酐(Cr)在術前及術后24h的濃度。觀察術后兩組患者中傷口感染、肺部并發(fā)癥和胃腸道并發(fā)癥的發(fā)生情況。結果兩組患者間的年齡、BMI、性別比例、ASA分級、失血量、尿量、補液量、手術時間、MAP、HR、CVP、Lac、Pa O2、Pcv O2、Scv O2差異無統(tǒng)計學意義。根據(jù)Fick公式計算:動脈血氧含量(Arterial oxygen content,Ca02)、靜脈血氧含量(Central Venous oxygen content,Ccv02)、動脈-靜脈血氧含量差(Difference of arteriovnous oxygen,Da-cv02)、氧攝取率(oxygen extraction rate,ER02),與B組相比,A組術中Hb、Ca O2、Ccv O2、Da-cv O2明顯降低(P0.05),兩組間ERO2差異無統(tǒng)計學意義。兩組患者術后腎功能指標、肺部并發(fā)癥和胃腸道并發(fā)癥發(fā)生率差異無統(tǒng)計學意義。結論在老年患者結直腸手術中,去氧腎上腺素與去甲腎上腺素在圍術期限制性輸液時能很好的維持組織灌注和氧供,對組織功能影響較小,但與去氧腎上腺素相比,去甲腎上腺素對老年患者氧含量的影響較小。
[Abstract]:Objective: the strategy of accelerated Recovery After SurgeryERASis is a safe and effective management strategy in perioperative period. Fluid management is the key factor affecting the outcome of accelerated rehabilitation surgery strategy in anesthetic management. It is related to the early recovery of intestinal function and the occurrence of complications. Clinical studies have shown that restrictive infusion can improve the prognosis of patients undergoing colorectal surgery and is a fluid management strategy in accordance with the concept of accelerated rehabilitation surgery. The effect of low dose norepinephrine on subclinical hypotension and tissue perfusion during restricted infusion has been verified. As a common vasoactive drug similar to norepinephrine pharmacology, the effect of noradrenaline on tissue oxygen metabolism in elderly patients with restricted infusion has not been studied. In this study, we observed the effect of noradrenaline on tissue oxygen metabolism in elderly patients with restricted infusion, and provided reference for the fluid management of colorectal tract surgery in elderly patients. Methods: sixty elderly patients undergoing elective colorectal resection were randomly divided into noradrenaline group (group A) and norepinephrine group (group B). The patients were given 12m1 KGG (-1) lactate Ringer's solution after entering the room, and then were infused at the speed of 5m1 KGG (-1) HX ~ (-1). After anesthesia induction, group A received 100 渭 g of norepinephrine during operation, followed by intravenous infusion of 0.1-0.3 渭 g / kg of noradrenaline) min~(-1).B group received 10 渭 g of norepinephrine at an equivalent load dose, followed by 0.01-0.03 渭 g / min of norepinephrine. The mean arterial pressure (mean Arterial pressure MAPP) 鈮，

本文編號：1774325