限制性输液联合去氧肾上腺素或去甲肾上腺素对老年肠道手术患者组织氧代谢的影响对比

Comparison of the effects of phenylephrine and norepinephrine on tissue oxygen metabolism in elderly patients undergoing fluid restriction

目的 比较老年肠道手术患者限制性输液联合去氧肾上腺素或去甲肾上腺素对组织氧代谢情况的影响。方法 选择择期行肠道手术的老年患者80例，美国麻醉医师协会分级Ⅰ~Ⅱ级。将患者按随机数字表法分为限制性输液联合去氧肾上腺素组（Ⅰ组）、限制性输液联合去甲肾上腺素组（Ⅱ组），每组40例。两组术中静脉滴注复方乳酸钠5 ml/（kg·h），Ⅰ组联合小剂量去氧肾上腺素，Ⅱ组则联合小剂量去甲肾上腺素，维持平均动脉压（MAP）≥ 65 mmHg（1 mmHg= 0.133 kPa），术中的失血量给予补充等容量羟乙基淀粉130/0.4氯化钠。分别于手术开始前（T0）、手术开始后1 h（T1）、手术开始后2 h（T2）和出手术室时（T3）行血气分析并检测血红蛋白等指标，并记录术后并发症情况。结果 两组MAP、中心静脉压（CVP）、心率、乳酸、动脉血氧分压、中心静脉血氧分压、中心静脉血氧饱和度、氧摄取率、血红蛋白、白蛋白、尿素氮、肌酐和并发症发生率比较差异无统计学意义（P〉0.05）。Ⅰ组T1~3血红蛋白、动脉血氧含量（CaO2），T1、T3静脉血氧含量（CcvO2）和T2动静脉血氧含量差（Da-cvO2）明显低于Ⅱ组[血红蛋白：（103.8 ± 7.9）g/L比（110.8 ± 8.6）g/L、（101.7 ± 7.7）g/L比（107.3 ± 7.8）g/L和（101.6 ± 6.9）g/L比（106.8 ± 5.6）g/L，CaO2：（140.6 ± 9.7）mmol/L比（149.6 ± 10.5）mmol/L、（137.5 ± 9.3）mmol/L比（144.9 ± 10.2）mmol/L和（137.2 ± 9.2）mmol/L比（143.1 ± 8.9）mmol/L，CcvO2：（119.8 ± 10.2）mmol/L比（126.4 ± 10.8）mmol/L和（102.3 ± 8.6）mmol/L比（108.5 ± 8.9）mmol/L，Da-cvO2：（19.6 ± 3.9）mmol/L比（23.0 ± 4.5）mmol/L]，差异有统计学意义（P〈0.05）。结论 老年肠道手术患者限制性输液联合去氧肾上腺素对组织氧代谢的影响要较去甲肾上腺素更大些。

Objective To investigate the effects of phenylephrine and norepinephrine on tissue oxygen metabolism in elderly patients undergoing fluid restriction.Methods Eighty elderly patients who had underwent elective colorectal surgery were selected, with ASA of Ⅰ-Ⅱ grade. The patients were divided into restricted fluid administration combined with phenylephrine group （group Ⅰ） and restricted fluid administration combined with norepinephrine group （group Ⅱ） by random digits table with 40 cases each. The compound recipe sodium lactate was given at a rate of 5 ml/（kg·h）. Small dose of phenylephrine was infused intravenously at 0.1-0.3 μg/（kg·min） simultaneously during the surgery in group Ⅰ, or norepinephrine 0.01-0.03 μg/（kg·min） in group Ⅱ. Mean arterial pressure （MAP） was maintained ≥ 65 mmHg （1 mmHg= 0.133 kPa）. The intraoperative blood loss was replaced with the equal volume of 6% hydroxyethyl starch 130/0.4. The blood gas analysis, hemoglobin and so on were determined before the surgery （T0）, 1 h after beginning of surgery （T1）, 2 h after beginning of surgery （T2） and at the time of leaving operation room （T3）. The complications were recorded.Results There were no statistical differences in MAP, central venous pressure （CVP）, heart rate, lactic acid, arterial partial pressure of oxygen, central venous oxygen pressure, central venous blood oxygen saturation, oxygen uptake rate, hemoglobin, albumin, blood urea nitrogen, creatinine and incidence of complication between 2 groups （P〉0.05）. The T1-3 hemoglobin and arterial oxygen content （CaO2）, T1 and T3 venous oxygen content （CcvO2） and T2 atrerial venous oxygen content differences （Da-cvO2） in group Ⅰ were significantly higher than those in group Ⅱ, hemoglobin： （103.8 ± 7.9） g/L vs. （110.8 ± 8.6） g/L, （101.7 ± 7.7） g/L vs. （107.3 ± 7.8） g/L and （101.6 ± 6.9） g/L vs. （106.8 ± 5.6） g/L; CaO2： （140.6 ± 9.7） mmol/L vs. （149.6 ± 10.5） mmol/L, （137.5 ± 9.3） mmol/L vs. （144.9 ± 10.2） mmol/L and （137.2 ± 9.2） mmol/L vs. （143.1 ± 8.9） mmol/L; CcvO2： （119.8 ± 10.2） mmol/L vs. （126.4 ± 10.8） mmol/L and （102.3 ± 8.6） mmol/L vs. （108.5 ± 8.9） mmol/L; Da-cvO2： （19.6 ± 3.9） mmol/L vs. （23.0 ± 4.5） mmol/L, and there were statistical differences （P〈0.05）.Conclusions Phenylephrine has more effect on tissue oxygen metabolism in the elderly patients undergoing fluid-restricted abdominal surgery.