小剂量去甲肾上腺素对神经外科手术中FloTrac/Vigileo监测系统指导目标导向液体治疗效果的影响

Effect of low-dose norepinephrine on efficacy of FloTrac/Vigileo system in guiding goal-directed fluidtherapy in neurosurgical procedures

目的评价小剂量去甲肾上腺素对神经外科手术中FloTrac/Vigileo监测系统指导目标导向液体治疗（GDT）效果的影响。 方法择期全麻下行开颅颅内肿物切除术患者90例，性别不限，ASA分级Ⅰ或Ⅱ级，年龄18～64岁，BMI 18～24 kg/m2，心功能分级Ⅰ或Ⅱ级，左室射血分数〉50%，采用随机数字表法分为3组（n＝30）：传统补液组（C组）、GDT组和小剂量去甲肾上腺素＋GDT组（NE＋GDT组）。C组根据4-2-1法则计算输液量，进行常规液体治疗。GDT组在FloTrac/Vigileo监测系统指导下根据每搏量变异度（SVV）进行液体治疗。NE＋GDT组在FloTrac/Vigileo监测系统指导下根据SVV进行液体治疗，同时静脉输注去甲肾上腺素0.01～0.03 μg· kg－1·min－1。记录术中总输液量、晶体液和胶体液用量、出血量、尿量和麻黄碱使用情况。于切皮前即刻和术毕时记录pH值、碱剩余（BE）、乳酸和血红蛋白（Hb）的浓度。 结果与C组比较，GDT组晶体液用量和尿量减少，胶体液用量增多，麻黄碱使用次数减少，术毕乳酸浓度降低，Hb浓度升高（P〈0.05或0.01）；GDT组和NE＋GDT组间总输液量、晶体液和胶体液用量、出血量、尿量、各时点pH值、BE、乳酸及Hb浓度比较差异无统计学意义（P〉0.05）。 结论神经外科手术中应用小剂量去甲肾上腺素（0.01～0.03 μg· kg－1·min－1）不会影响FloTrac/Vigileo监测系统指导GDT的效果。

Objective To evaluate the effect of low-dose norepinephrine on the efficacy of FloTrac/ Vigileo system in guiding goal-directed fluid therapy （GDT） in neurosurgical procedures. Methods Ninety American Society of Anesthesiologists physical status I or 1] patients of both sexes, aged 18-64 yr, with body mass index of 18-24 kg/m2, of New York Heart Association class I or II , with left ven- tricular ejection fraction〉50%, were divided into 3 groups （n = 30 each） using a random number table： control group （group C） , group GDT and low-dose norepinephrine plus GDT group （group NE＋GDT）. The total volume of fluid infused was calculated according to the 4-2-1 rule, and routine fluid therapy was performed in group C. Fluid therapy was performed according to stroke volume variation （SVV） under the guidance of FloTrac/Vigileo system in group GDT. In group NE＋GDT, fluid therapy was performed accord- ing to SVV under FloTrac/Vigileo system guidance, and norepinephrine 0, 01-0.03 μg· kg-1·min-1 was intravenously infused at the same time. The total volume of fluid infused, amount of crystalloid solution and colloid solution infused, blood loss, urine volume and requirement for ephedrine were recorded during op- eration. The pH value, base excess, blood lactate and hemoglobin （Hb） were recorded immediately be- fore skin incision and at the end of operation. Results Compared with group C, the amount of crystalloidsolution infused and urine volume were significantly reduced, the amount of colloid solution infused was in- creased, the requirement for ephedrine was reduced, the concentration of blood lactate was decreased at the end of operation, and the concentration of Hb was increased in group GDT （ P〈0.05 or 0. 01 ）. There were no significant differences between GDT group and NE＋GDT group in the total volume of fluid infused, a- mount of crystalloid solution and colloid solution infused, blood loss, urine volume, blood lactate concen- tration at each time point, pH value, base excess or Hb concentrations （P 〉 0.05）. Conclusion Appli- cation of low-dose norcpinephrine （0.01-0.03 μg· kg-1·min-1） in neurosurgical procedures does not affect the efficacy of FloTrac/Vigileo system in guiding GDT.