去甲肾上腺素用于巨脾切除术的研究

The study of norepinephrine during megalosplenia actomy.

目的研究巨脾切除时脾动脉内注射去甲肾上腺素对脾内血液回输的有效性和安全性。方法将64例诊断巨脾患者分为两组,每组32例。Ⅰ组在脾动脉内注射0.0004%去甲肾上腺素2ml/kg;Ⅱ组在脾动脉内用球后针注射0.0008%去甲肾上腺素2ml/kg。在脾动脉注射去甲肾上腺素同时,视平均动脉压注射0.05%酚妥拉明以保持血压平稳。结果从脾动脉注射去甲肾上腺素至结扎脾静脉整个过程持续约15～20min,患者血压波动<30mmHg、心率变化<35次/min、动脉血氧饱和度≥99%,呼末二氧化碳在28～35mmHg之间。两组小便:Ⅰ组300ml/h,Ⅱ组320ml/h。两组出血均<80ml。两组患者在注药后脾脏前后、左右周径和脾脏厚度与注药前相比差异有统计学意义。通过生理盐水注入脾静脉恢复脾脏原位,得出脾内血液回流量Ⅰ组(1100±352)ml,Ⅱ组为(1200±411)ml,两组之间差异无统计学意义。结论巨脾切除时脾动脉内注射0.0004%去甲肾上腺素和0.0008%去甲肾上腺素都能够明显缩小脾脏,增加脾血回流,降低输血发生率。两个浓度之间效果无明显差异,建议用较小浓度0.0004%去甲肾上腺素。

Objective To investigate the efficacy and safety of splenic artery injection of norepinephrine for regurgitation spleen blood during megalosplenia ectomy.Methods Sixty four patients diagnosed megalosplenia were allocated into 2 groups.0.0004% norepinephrine（2ml/kg,I group） or 0.0008% norepinephrine（2ml/kg,Ⅱ grouop）was injected from splenic artery.During the period of norepinephrine injection,0.05% phentolamine was slowly injected from central venous catheter to control the blood pressure.Results The period from norepinephrine injection to ligation of splenic vein lasted 15～20 min,during which,the changes of blood pressure and heart rate were less than 30 mmHg and 35 bpm,respectively the SpO2 was higher than 99%,the PETCO2 was between 28～35mmHg.The urine volume was 300ml/h in the I group and 320ml/h in the II group.The blood loss in both groups was less than 80ml and the spleen size was greatly decreased after norepinephrine injection.There were significant differences in the front to back and left to right perimeters and thickness of spleen before and after norepinephrine injection.Blood regurgitation volume were（1100±352）ml in the I group and（1200±411）ml in the II group,and there were no significant differences.The indexs in the blood routine analysis were incresed in the two groups,but there were no significant differences in two groups.Conclusion Injection of 0.0004% and 0.0008% norepinephrine from splenic artery greatly reduced the size of spleen and increased the blood regurgitation volume.The patients in the two groups did not receive additional blood transfusion and without serious complications.There were no significant differences of effect between the two groups,and then we suggested for using 0.0004% norepinephrine during splenectomy.