艾司洛尔对全麻下输注乳酸林格液在体内分布和排泄的影响

Effect of Esmolol on the distribution and clearance of lactated Ringer' s solution during general anesthesia

目的探讨小剂量艾司洛尔对全麻下妇科腹腔镜手术患者输注乳酸林格液的分布和排泄的影响。方法对40例ASA I级择期行妇科腹腔镜手术患者按随机数字表法分为对照组(C组)和艾司洛尔组(E组),每组20例。所有患者在30min内输入20ml/kg的乳酸林格液,E组患者给予艾司洛尔50μg/(kg·min)持续输注3h,C组以相同速度输注0.9%氯化钠溶液。通过血红蛋白稀释-时间曲线和尿量计算容量动力学参数。结果乳酸林格液容量动力学特征采用二室容量动力学模型拟合。与C组比较,E组清除速率常数(k_(10)))明显升高(P=0.020),而外周室到中央室转运速率常数(k_(21)))降低(P=0.021)。中央室到外周室转运速率常数(k_(12))和中央室容积(V_1)比较差异无统计学意义(P=0.312、0.235)。C组和E组患者3h内分别将输入液体8.8%和20.4%通过尿量排出(P=0.007)。结论小剂量艾司洛尔减缓妇科腹腔镜手术患者乳酸林格液从血浆向组织间液转移,促进液体从尿液排泄,因此艾司洛尔可以部分对抗麻醉手术应激所致的抗利尿作用。

】Objective To evaluate the effects of low dose esmolol on the distribution and clearance of lactatedRinger＇s solution in patients during gynecologic surgery under general anesthesia. Methods Forty patients with ASA（American Society of Anesthesiologist） physical status I scheduled for laparoscopic gynecologic surgery were randomizedinto control group （group C, n=20） and esmolol group （group E, n=20）. All patients received 20ml/kg of lactated Ringer＇ssolution within 30min. The patients in Group E were given a continuous infusion of esmolol at rate of 50μg/kg/min for 3 h,while the patients in Group C received normal saline with the same speed. The kinetics of Ringer＇s solution was calculatedby plasma dilution（based on hemoglobin） and urinary excretion. Results The kinetics of Ringer＇s solution was described bytwo-kinetic model. Compared with Group C, the elimination rate constant （k10） in Group E increased significantly（P=0.020）,and the transfer rate constant from peripheral space to central space （k21, P=0.021） decreased significantly. The transfer rateconstant from central space to peripheral space（k12） and the central volume （V1）（P=0.312, 0.235） were comparable betweentwo groups. Average 8.8% and 20.4% of the infused volume were excreted within 3 h in groups C and E, respectively （P=0.007）. Conclusion Low dose esmolol can slow down the distribution of fluid from the plasma to the interstitial fluid space andpromote urine excretion, thereby partially reversing the antidiuretic effect of anesthesia and surgery.【