低剂量去甲肾上腺素对老年患者前列腺癌根治术全麻诱导期血压的影响

Effects of low dosage norepinephrine on blood pressure in elderly patients undergoing radical prostatectomy during induction of general anesthesia

目的观察低剂量去甲肾上腺素(NE)持续输注对机器人辅助腹腔镜下前列腺癌根治术(RALRP)老年患者全麻诱导期血压的影响。方法择期行RALRP老年患者60例,随机分为NE组(n=30)和对照组(n=30)。NE组从麻醉诱导开始至切皮前持续静脉泵注NE 2~5μg·kg^(-1)·h^(-1);对照组以同等速度静脉泵注生理盐水。记录麻醉诱导前(T_(0))、全麻诱导气管插管前(T_(1))、气管插管后即刻(T_(2))和插管后到切皮前(T_(3))的基础动脉收缩压(SBP)、舒张压(DBP)和心率(HR)。结果2组患者T_(1)和T_(3)时SBP、DBP、HR水平均显著低于T_(0)(P<0.05)。NE组患者在T_(1)、T_(3)时的SBP和DBP值均显著高于对照组(P<0.05),全麻诱导期低血压的发生率显著低于对照组(26.67%vs 73.33%),术后首次下床活动时间及术后住院时间较对照组显著缩短(P<0.05)。2组患者15项术后恢复质量评分比较差异无统计学意义(P>0.05)。结论低剂量NE持续泵注可安全有效缓解全麻诱导期间的血压下降并减少低血压的发生率,缩短术后住院时间。

AIM To evaluate the effects of continuous infusion of low dosage norepinephrine(NE)on blood pressure changes in elderly patients undergoing robot assisted laparscopic radical prostatectomy(RALRP)during the induction general anesthesia.METHODS A total of 60 patients undergoing RALRP were enrolled in this prospective protocol and randomised them to NE group(n=30)and control group(n=30).NE group was administered with 2-5μg·kg^(-1)·h^(-1)NE by injection pump from the beginning anesthetic induction to surgical incision,while control group received saline infusion at the same speed.Systolic blood pressure(SBP),diastolic pressure(DBP)and heart rate(HR)were recorded at the following time points:before general anesthesia induction(T_(0)),time before endotracheal intubation corresponding to the lowest SBP(T_(1)),immediate post-intubation(T_(2)),point of time corresponding to the lowest SBP between intubation and skin incision(T_(3)).RESULTS Compared with T_(0),SBP,DBP and HR were decreased significantly in both groups at T_(1)and T_(3)(P<0.05).SBP and DBP in NE group were significantly higher than those in control group at T_(1)and T_(3)(P<0.05).The incidence of hypotension during induction of general anesthesia was significantly lower in NE group(26.67%)than that in control group(73.33%).The first ambulation time and postoperative hospital stay were significantly shortened in NE group(P<0.05).There was no significant difference in quality of recovery-15 scores between 2 groups(P>0.05).CONCLUSION In summary,continuous infusion of low dose NE could effectively improve the stability of blood pressure,reduce the occurrence of hypotension during general anesthesia induction and length of postoperative hospital stay.