磷酸肌酸钠预处理对老年患者全膝关节置换骨水泥植入术中循环功能的保护作用

Protective effect of creatine phosphate sodium pretreatment on circulatory function in total knee replacement surgery using bone cement implantation

目的探讨磷酸肌酸钠预处理对老年患者单侧全膝关节置换骨水泥植入术中循环功能的保护作用。方法择期行单侧全膝关节置换骨水泥植入手术的老年患者40例,随机分为两组,每组20例。麻醉诱导后经口置入食道超声多普勒探头。CP组予磷酸肌酸钠2g加入生理盐水100ml中,在手术开始前30min静脉滴注,NS组给予等量生理盐水。记录骨水泥植入前(T_0)、骨水泥植入后1min(T_1)、3min(T_2)、5min(T_3)、10min(T_4)的SBP、DBP、HR、SpO_2、PETCO_2、BIS,以及心排血量(CO)、每搏量(SV)及左心室舒末容积(LVEDV)。记录围术期Ⅱ导联心电图心律失常的发生情况。结果 T_2、T_3时NS组SBP、DBP明显低于CP组,HR明显慢于CP组(P<0.05);NS组CO、SV明显低于CP组,LVEDV明显高于CP组(P<0.05)。CP组心律失常发生率明显低于NS组(P<0.05)。结论磷酸肌酸钠预先给药能有效减轻全膝关节置换术中骨水泥植入引起的血流动力学波动,减少骨水泥植入综合征(BCIS)的发生率,对BCIS有一定的预防作用。

Objective This study is to investigate the protective effect of creatine phosphate so-dium on circulatory function in unilateral total knee replacement surgery using bone cement implanta-tion.Methods Forty patients undergoing unilateral total knee replacement surgery with bone cement were randomly assigned into 2 groups：test group （group CP,n=20）and control group （group NS, n=20）.The easophageal doppler ultrasound probe was placed at the level of the third rib transorally after induction in each patient.In group CP,creatine phosphate sodium （2 g in 100 ml normal saline） was infused （within 30 min）at 30 min before the operation,as well as normal saline 100 ml in group NS.SBP,DBP,HR,SpO2 ,PET CO2 and BIS were monitored and recorded before （T0 ）and 1 （T1 ）,3 （T2 ）,5 （T3 ）,10 （T4 ）min after insertion of bone cement.Cardiac output （CO）,stroke volume （SV）and left ventricular end-diastolic volume （LVEDV）were simultaneously monitored and recorded with esophageal doppler ultrasound.WhileⅡ-lead electrocardiogram were recorded to monitor ven-tricular arrhythmia perioperatively.Results SBP,DBP and HR decreased at T2 and T3 in group NS, and were lower than those in group CP （P 〈0.05 ）;Meanwhile,compared with group CP,CO and SV were significantly lower,while LVEDV was significantly higher in group NS （P 〈0.05 ）.Com-pared with T0 ,CO and SV decreased and LVEDV increased at T2 and T3 in group NS （P 〈0.05 ）. After insertion of bone cement,the incidence of arrhythmia in group CP was obviously lower than that in group NS （P 〈 0.05 ）.Conclusion Pretreatment with creatine phosphate sodium can effectively prevent the incidence of bone cement implantation syndrome （BCIS）by stabilizing hemodynamic in elderly patients undergoing total knee replacement with bone cement.