【摘要】：目的探討持續(xù)泵注小劑量去甲腎上腺素對單肺通氣患者血乳酸及心肌酶的影響。方法選擇在單肺通氣下行肺葉切除術(shù)患者60例,隨機(jī)分成小劑量去甲腎上腺素組(N組)和多巴胺組(D組),每組30例。術(shù)前補(bǔ)足禁食禁水、生理需要量,晶體與膠體按2:1給予,晶體為生理鹽水,膠體為琥珀酰明膠注射液,N組于麻醉誘導(dǎo)即刻持續(xù)泵注小劑量去甲腎上腺素[0.01~0.03μg/(kg·min)],D組于麻醉誘導(dǎo)即刻持續(xù)泵注多巴胺[1~3μg/(kg·min)]。兩組根據(jù)患者基礎(chǔ)平均動脈壓在上述范圍內(nèi)調(diào)整去甲腎上腺素、多巴胺及麻醉藥物泵注速率使平均動脈壓維持在基礎(chǔ)值±30%,腦電雙頻指數(shù)(BIS)值45~60。如血壓仍不能維持,單次給予靜脈注射去甲腎上腺素10μg,多巴胺1 mg,分別于誘導(dǎo)前(T0)、誘導(dǎo)后(T1)、單肺通氣即刻(T2)、單肺通氣30 min(T3)、單肺通氣90 min(T4)、手術(shù)結(jié)束即刻(T5)時間點(diǎn)取橈動脈血行血?dú)夥治鲇涗浹樗岷?上述各時間點(diǎn)及術(shù)后24 h(T6)取中心靜脈血檢測心肌酶[乳酸脫氫酶(LDH)、α-羥丁酸脫氫酶(α-HBDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)]濃度,記錄各組患者手術(shù)后自然蘇醒時間(手術(shù)結(jié)束至能按指令睜眼時間)。結(jié)果各組內(nèi)與T0~T3比較,T4~T5動脈血乳酸含量顯著升高,T5~T6時刻LDH、α-HBDH、CK及CK-MB濃度均比T0~T4時刻顯著升高,但均在正常范圍內(nèi);組間比較兩組血乳酸含量在T0~T4時刻差異無統(tǒng)計學(xué)意義(P0.05),在T5時刻N(yùn)組明顯低于D組;平均術(shù)后自然蘇醒時間N組明顯短于D組;心肌酶含量兩組比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論持續(xù)泵注小劑量去甲腎上腺素能增加單肺通氣患者血乳酸清除,縮短患者自然蘇醒時間且對心肌酶無不利影響。
[Abstract]:Objective to investigate the effects of low dose norepinephrine on blood lactic acid and myocardial enzymes in patients undergoing single lung ventilation. Methods Sixty patients undergoing lobectomy under single lung ventilation were randomly divided into two groups: low dose norepinephrine group (group N) and dopamine group (group D) with 30 cases in each group. Before operation, supplement fasting water, physiological requirements, lens and colloid according to 2:1, the lens is normal saline, The colloid was succinyl gelatin injection. Group N was injected with low dose of norepinephrine (0.01g / (kg min) immediately after anesthesia induction, and group D was injected with dopamine (1 3 渭 g / (kg min) immediately after induction of anesthesia. The two groups adjusted norepinephrine, dopamine and anaesthetic pump injection rate to maintain the mean arterial pressure at base 鹵30, and EEG bispectral index (BIS) 45 ~ 60. If the blood pressure is still not maintained, Single intravenous injection of norepinephrine 10 渭 g, dopamine 1 mg, before (T0), after induction (T1), immediately after one-lung ventilation (T2), 30 min of single-lung ventilation (T3), 90 min of single-lung ventilation (T4), blood gas analysis of radial artery at the end of operation (T5) The content of lactic acid in blood was recorded. Myocardial enzyme (LDH), 偽 -hydroxybutyrate dehydrogenase (CK-MB) was measured at each time point and 24 h after operation (T6), and the concentration of (CK), creatine kinase isoenzyme (CK-MB) was measured. The time of spontaneous recovery after operation (from the end of operation to the time of opening eyes as instructed) was recorded. Results compared with T0~T3, the content of lactic acid in arterial blood of T4~T5 was significantly increased, and the concentrations of LDH, 偽-HBDH,CK and CK-MB in T5~T6 were significantly higher than those in T0~T4, but they were within the normal range. There was no significant difference in blood lactic acid content between the two groups at T0~T4 time (P0.05). At T5 time N group was significantly lower than D group; the average postoperative spontaneous recovery time in N group was significantly shorter than that in D group; there was no significant difference in myocardial enzyme content between the two groups (P0.05). Conclusion continuous infusion of low dose norepinephrine can increase the clearance of blood lactic acid in patients with single lung ventilation, shorten the time of spontaneous recovery and have no adverse effect on myocardial enzymes.
【作者單位】： 南昌大學(xué)研究生院醫(yī)學(xué)部;南昌大學(xué)第一附屬醫(yī)院麻醉科;
【分類號】：R614

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