羟乙基淀粉预扩容对婴儿腹腔镜术中胃黏膜灌注的影响

Effect of Volume Preloading with Hydroxyethyl Starch on Gastric Mucosal Perfusion in Infants Undergoing Laparoscopic Surgery

目的探讨羟乙基淀粉预扩容在婴儿腹腔镜手术期间对内脏的保护作用及机制。方法选择30例腹腔镜下手术的患儿,年龄1d～4个月,按随机数字表法分为对照组、乳酸林格氏液(RL)组(RL组)及0.9%氯化钠6%羟乙基淀粉(HES)组(HES组),每组10例。麻醉诱导行预扩容,RL组予4mL.kg-1的RL液,HES组予4mL.kg-1的HES;对照组不进行扩容。扩容结束后比较3组切皮前(T1)、气腹后5min(T2)和30min(T3)及结束气腹后5min(T4)和30min(T5)5个时间点的胃黏膜-血CO2分压差(Pg-a CO2)、血浆肾上腺素及去甲肾上腺素的质量浓度。结果 Pg-a CO2值、血浆肾上腺素及去甲肾上腺素质量浓度比较:3组T2、T3时间点较T1时明显上升(P<0.01),T2、T3时无明显变化,T4、T5时3组均下降至T1时间点水平;T1、T4、T5时3组差异无统计学意义(P>0.05);T2、T3时HES组较RL组、对照组明显降低(P<0.05),RL组与对照组比较差异无统计学意义(P>0.05)。结论 6%羟乙基淀粉预扩容可减轻腹腔镜手术期间胃黏膜的低灌注状态。

Objective To explore the effect of volume preloading with hydroxyethyl starch（HES） on gastric mucosal perfusion in infants undergoing laparoscopic surgery.Methods Thirty infants undergoing laparoscopic surgery,aged less than 4 months,were randomly divided into three groups,with 10 infants in each group.The RL group and HES group were given volume preloading with lactated Ringer’s solution（4 mL·kg-1） and HES（6% solution in 0.9% sodium chloride）,respectively.The control group was not given volume preloading.The partial pressure difference of CO2 between gastric mucosa and arterial blood（Pg-a CO2） was monitored and the levels of serum epinephrine（E） and norepinephrine（NE） were detected after volume preloading（T1）,5 minutes after pneumoperitoneum（T2）,30 minutes after pneumoperitoneum（T3）,5 minutes after the end of pneumoperitoneum（T4） and 30 minutes after the end of pneumoperitoneum（T5）.Results Compared with T1,the values of Pg-a CO2 and the concentrations of serum E and NE significantly increased at T2 and T3（P〈0.01）.No obvious differences were found between T2 and T3,as well as among T1,T4 and T5（P〈0.05）.Compared with HES group,the values of Pg-a CO2 and the concentrations of serum E and NE significantly increased in RL group and control group at T2 and T3（P〈0.05）.The differences were not significant between RL group and control group（P〈0.05）.In addition,there were no obvious differences among the three groups at T1,T4 and T5（P〈0.05）.Conclusion Volume preloading with 6% HES can relieve gastric mucosal perfusion during laparoscopic surgery.