间羟胺对骨水泥置入老年患者的影响

Effects of metaraminol on hemodynamics and tissue oxygen metabolism in elderly patients undergoing total knee arthroplasty and cement implantation

[目的]探讨间羟胺对老年全膝关节置换骨水泥置入患者组织氧代谢的影响。[方法]选取本院择期初次行单侧骨水泥型全膝关节置换术的老年患者60例,采用随机数字表法,随机分为生理盐水组(盐水组)和间羟胺组(间羟胺组),每组30例。间羟胺组在扩髓腔时给予间羟胺0.03~0.3μg/(kg·min)持续静脉泵注,盐水组给予生理盐水泵注。术中血压低于30%基础血压静脉单次给予0.1~0.2 mg间羟胺静注。记录两组患者于骨水泥置入前(T0)、骨水泥置入后5 min(T1)、10 min(T2)、30 min(T3)的平均动脉压(MAP)、中心静脉压(CVP)、心率(HR),采集动脉血和中心静脉血的血样,进行血气分析,同时,记录围术期Ⅱ导联心电图心律失常的发生情况,记录术后患者恶心、呕吐发生情况。[结果]与T0比较,盐水组患者在T1和T2的MAP、PaO2、PcvO2、ScvO2、Lac、CaO2、CcvO2均降低、HR、Da-cvO2、ERO2均升高;与盐水组比较,在T2时间羟胺组患者MAP、PaO2、PcvO2、ScvO2、Lac、CaO2、CcvO2均升高,HR、Da-cvO2、ERO2均降低。与盐水组比较,间羟胺组患者术中心律失常的发生率和术后恶心呕吐发生率均降低。[结论]间羟胺改善老年患者全膝关节置换术中骨水泥置入引起的血流动力学的变化,有效保证组织氧代谢。

[Objective]To investigate the effects of metaraminol on hemodynamics and tissue oxygen metabolism in elderly patients undergoing total knee arthroplasty and cement implantation.[Methods]Sixty elderly patients undergoing unilateral cemented total knee arthroplasty were randomly divided into saline infusion group and metaraminol infusion group with 30 cases in each group by random numerical table method.The patients in metaraminol infusion group received intravenous infusion of metaraminol 0.03~0.3 ug/kg/min while saline infusion group received saline infusion.Metaraminol(0.1~0.2 mg)should be injected by intravenous,when blood pressure was below 30%of baseline blood pressure during operation.Mean arterial pressure(MAP),central venous pressure(CVP)and heart rate(HR)were measured before cement implantation(T0),5 minutes(T1),10 minutes(T2)and 30 minutes(T3)after cement implantation in both two groups.Blood samples of arterial blood and central venous blood were collected for blood gas analysis,arterial blood lactate concentration(Lac),hemoglobin volume(Hb),arterial partial pressure of oxygen(PaO2),central venous oxygen saturation(ScvO2),and partial pressure of central venous oxygen(PcvO2)were recorded.According to Fick formula,arterial oxygen content(CaO2),central venous oxygen content(CcvO2),arterial venous oxygen difference(Da-cvO2),and oxygen uptake rate(ERO2)were calculated.Perioperative arrhythmia of lead II electrocardiogram and postoperative nausea and vomiting were recorded.[Results]Compared with thos at T0,MAP,PaO2,PcvO2,ScvO2,Lac,CaO2,and CcvO2 of patients decreased,and HR,Da-cvO2,and ERO2 increased at T1 and T2 in saline infusion group.Compared with saline infusion group,MAP,PaO2,PcvO2,ScvO2,Lac,CaO2,and CcvO2 of patients increased,and HR,Da-cvO2,and ERO2 decreased at T2 in metaraminol infusion group.Compared with saline infusion group,the incidence of intraoperative arrhythmia and postoperative nausea and vomiting decreased in metaraminol infusion group.[Conclusion]Metaraminol improves the hemodynamic changes caused by cement implantation during total knee arthroplasty in elderly patients,and effectively ensures tissue oxygen metabolism.