磷酸肌酸预处理对老年全麻患者俯卧位下循环功能的保护作用

Protective effects of creatine phosphate pretreatment on circulatory function in prone position in elder patients with general anesthesia

目的:探讨磷酸肌酸(CP)预处理对老年全麻患者俯卧位状态下循环功能的保护作用。方法:拟择期在俯卧位下行右侧经皮肾镜碎石术患者40例,性别不限,年龄60~75岁,ASAⅠ或Ⅱ级,随机数字表法分为两组:对照组(N组)和磷酸肌酸组(P组),每组20例。P组将磷酸肌酸钠以30 mg/kg溶入50 m L的生理盐水中于麻醉诱导前30 min以100 m L/h速度持续泵注,N组于同时间点泵注等容量生理盐水。分别于俯卧位前1 min(T_0)、俯卧位后1 min(T_1)、3 min(T_2)、5 min(T_3)、10 min(T_4)时记录患者的HR、MAP、CO、SV、CVP、脉压差变异率(PPV)及体循环外周阻力(SVR)。记录术中血管活性药物的使用情况。结果:与T0相比,N组患者T1时HR明显升高(P<0.05),T_1~T_3时MAP、CO、SV明显降低,PPV、CVP、SVR明显增加(P<0.05);与N组相比,P组T_1~T_2时MAP、CO、SV明显升高,PPV、CVP、SVR明显降低(P<0.05),俯卧位后血管活性药物调控次数明显减少(P<0.05)。结论:CP预先给药能有效改善老年全麻患者俯卧位引起的血流动力学变化,对体位改变引起的循环功能代偿不全有一定的保护作用。

Objective To investigate the protective effects of creatine phosphate pretreatment on circulatory function in prone position in elder patients with general anesthesia. Methods Forty patients in ASA physical status I or II of male and female, aged 60 to 75 years undergoing percutaneous nephrolithotripsy in prone position, were randomly divided into two groups （n = 20 each） ： the control group （group N） and the creatine phosphate group （group P）. In the group P, creatine phosphate sodium （30mg·kg-1 in 50 mL normal saline） was continuous infused at a speed of 100 mL·h-1, while only normal saline 50 mL in the group N at the same time. HR, MAP, CO, SV, CVP, Pulse Pressure Variation （PVV） and Systemic Circulation Resistance （SVR） were monitored and recorded at 1 rain before prone position （T0） and 1 min （T1） , 3 min （T2）, 5 min （%） , 10 min （T4） after prone position. The requirement for vasoactive agents were also recorded. Results Compared with To, HR began to increase significantly at T1 in the group N（P 〈 0.05）, while MAP, CO and SV began to decrease at T1 to Y3, and CVP, PVV and SVR began to increase significantly at the same time in the group N （P 〈 0.05）. Compared with the group N, MAP, CO and SV were decreased, PPV, CVP and SVR were increased significantly at T1 to T2 in the group P （P 〈 0.05）. The requirement for vasoactive agents in the group P was obviously lower than that in the group N （P 〈 0.05）. Conclusion Creatine phosphate pretreatment can stabilize the hemodynamic change effectively, and prevent the adverse cardiovascular events caused by prone position in eider patients with general anesthesia.