大剂量去甲肾上腺素对食管癌术后吻合口愈合的影响

Effects of large dose norepinephrine on the anastomotic healing after esophagectomy

目的探究食管癌术后应用大剂量去甲肾上腺素对吻合口愈合的影响。方法回顾性分析2014年1月至2016年6月行手术治疗的148例食管癌患者的临床资料，将术后前4 d内因低血压等因素应用了25.0～67.0 mg[（32.6±2.3） mg]剂量的去甲肾上腺素的7例患者设为研究组，其余未应用或应用剂量较小的141例患者设为对照组，将两组患者术后吻合口愈合状况及瘘的发生率进行比较。结果研究组与对照组术后分别有3例与7例患者发生了吻合口瘘，其吻合口瘘的发生率分别为42.86%（3/7）与4.96%（7/141），两组比较差异有统计学意义（χ2＝9.78，P＝0.001），且研究组有2例术后出现了程度不同的残胃坏死，均发生在去甲肾上腺素应用剂量大、时间长的患者中。结论食管癌术后长时间与大剂量应用去甲肾上腺素有增加吻合口瘘与导致残胃坏死的风险，应引起临床医师足够的重视。

Objective To explore the impact of using large dose norepinephrine on the anastomotic healing after esophagectomy.Methods Clinical data of data of 148 cases patients with esophageal cancer who were treated in Wuwei Tumor Hospital of Gansu Province with surgery from January 2014 to June 2016 were retrospectively analized.There were 7 patients who were used 25-67 mg（（32.6±2.3） mg） norepinephrine because of the low blood pressure and other factors during the first 4 d postoperative as research group, and the other 141 patients who had not applied or applied the small dose were set as control group.The patients of two groups with postoperative anastomotic healing and fistula incidence were compared.Results There were 3 cases and 7 cases of postoperative patients appeared anastomotic fistula in the research group and the control group, the rate of anastomotic fistula were 42.86%（3/7） and 4.96%（7/141） respectively, the difference was significant（χ2=9.78, P=0.001）, and 2 cases appeared varying degrees residual gastric necrosis in the research group, all of them occurred in the patients with large dosage and long time.Conclusion There are great risk on the anastomotic fistula and residual stomach mecrosis if long time and large dose norepinephrine was used after esophagectomy, it should be caused enough attention for surgeons.