参附注射液对肺叶切除术患者血流动力学及血气分析指标的影响

Effect of Shenfu Injection on Hemodynamics and Blood Gas Analysis in Patients Undergoing Lobectomy of Lung combined Epidural Block and General Anesthesia

目的:探讨参附注射液对全麻复合胸段硬膜外阻滞下行肺叶切除术患者血流动力学及血气分析指标的影响。方法:将60例拟在胸段硬膜外阻滞复合全麻下肺叶切除术病人,随机双盲法分为参附组(n=30)及对照组(n=30),参附组在麻醉诱导前静脉输注参附注射液1.5mL/kg;对照组以同样速度输注等量的生理盐水。结果:与对照组相比,参附组的MAP、HR在诱导后5min(T1)、手术探查时(T2)、单肺通气30min(T3)、单肺通气60min(T4)及关胸前冲洗胸腔时(T5)升高(P<0.05),术中麻黄碱、阿托品的使用量及输液总量减少(P<0.05),PaO2在T3、T4时较对照组升高(P<0.05),麻醉药物用量等两组比较无差异(P>0.05)。结论:参附注射液对胸段硬膜外阻滞复合全麻下肺叶切除术患者血流动力学变化具有稳定作用,可改善单肺通气期间血气分析指标。

Objective To investigate the effect of Shenfu Injection on hemodynamics and blood gas analy-sis in patients undergoing lobectomy of lung com- bined thoracic epidural block and general anesthesia.Methods A double blind trail was conducted on 60 patients undergoing lobectomy of lung combined thoracicepidural block and general anesthesia.The patients were randomly divided into Shenfu Injection group （n=30）and control group （n=30）. In the Shenfu Injection group, 1.5 mL/kg Shenfu Injection diluted with 250 mL salinewere given before anesthesia introduction. In the control group, equal saline were given at the same time. The fol-lowing indexes were observed： （1） MAP,HR and CVP at the time before anesthesia introduction（TO）, after anes-thesia introduction for 5 minutes （T1）, surgical exploration （T2）,after one-lung ventilation for 30 minutes （T3）, af-ter one-lung ventilation for 60 minutes（T4）, rinse chest（T5） and the end of operation（T6）.（2）the dose of atropine and ephedrine, the amount of intraoperative transfusion,blood loss, urine volume and duration of surgery.（3） the dose of ropivaeaine, propofol, fentanyl and vecuronium; （4）the blood gas analysis was detected at the time of T1, T3,T4 and T6. Results Compared with the control group, MAP and HR increased at the time of T1, T2, T3, T4and T5 （P〈0.05）, the amount of intraoperative transfusion, the dose of atropine and ephedrine were lower （P〈0.05）, PaO2 increased at the time of T3 and T4 （P〈 0.05）in Shenfu Injection group .There wre no diference inthe other observation indexes（P 〉 0.05）. Conclusion Shenfu Injection reflects a stable effect on hemodynam-ics in patients undergoing lobectomy of lung combined thoracic epidural block and general anesthesia,and a bet- ter outcome on the blood gas analysis in duration of one-lung ventilation.