磷酸肌酸钠对骨科全麻应用止血带患者的血流动力学影响

The hemodynamic effect of sodium phosphocreatine used in orthopedic anesthesia operation applying tourniquet

目的探讨磷酸肌酸钠在骨科全麻手术中使用止血带的血流动力学影响及其对止血带反应的预防作用。方法选取在气管插管全麻下行骨科下肢手术的患者共70例,分为处理组和对照组,处理组较对照组在手术麻醉后止血带加压前加用预防性使用磷酸肌酸钠处理,记录两组患者的止血带充气时间、术中不同时间段进行血流动力学指标检测,在使用止血带开始前5 min和手术结束后松解止血带时抽动脉血比较两组患者的乳酸(LAC)、pH值。结果与对照组比较,平均动脉压(MAP)、舒张压(DBP)在使用止血带后30 min(T3)、放气后10 min(T5)、心率(HR)、收缩压(SBP)、心排量(CO)在T3、使用止血带后60 min(T4)、T5均显著降低,血流动力学异常发生率、T5时处理组的LAC值显著降低,但两组的每搏输出量(SV)在T1~T5值比较差异无显著。结论磷酸肌酸钠能减轻骨科全麻手术中使用止血带的血流动力学异常发生率,同时具有减轻使用止血带后乳酸堆积的作用。

Objective To study the hemodynamic effects of sodium phosphocreatine in orthopaedics anesthesia surgery using tourniquet and the prevention effect of tourniquet reaction. Methods 70 patients with lower extremity surgery were selected undergoing the endotracheal intubation anesthesia to perform lower limb orthopaedics operation,which were divided into treatment group and control group.In the treatment group sodium phosphocreatine was preventive used before tourniquet pressure after anesthesia compare with the control group. The tourniquet filling time,hemodynamic indexes in different periods of two groups and the blood lactic acid,p H value in the use of a tourniquet 5 min before and after the surgery when release the tourniquet arterial were compared. Results Compared to control group,the values of MAP and DBP in T3 and T5,HR,SBP,CO in T3,T4,T5 in the treatment group was significantly lower,but SV on T1 ~ T5 of two groups has no statistical significance. The incidence of abnormality in hemodynamic and T5 LAC of the treatment group was lower. Conclusion Sodium phosphocreatine can reduce the incidence of hemodynamic abnormalities when using tourniquet in the orthopaedics anesthesia surgery,at the same time,which had the effect that reduced lactic acid accumulation after using tourniquet in the orthopaedics surgery.