甲氧明对老年胃肠肿瘤手术患者肾功能的影响

Effects of Methoxamine on Renal Function of Elderly Patients Undergoing Gastrointestinal Tumor Surgery

目的观察术中持续泵注甲氧明对老年胃肠肿瘤手术患者术后肾功能及预后的影响。方法择期在全身麻醉下行胃肠道肿瘤手术患者162例,年龄65岁以上,ASAⅠ~Ⅲ级。采用数字表法随机分为两组,M组于诱导前2min以2μg/(kg·min)泵注甲氧明,N组诱导前无预防性用药,于诱导前2min泵注0.9%氯化钠溶液。记录入室时(T 0)、诱导前2min(T 1)、插管后10min(T 2)、手术开始时(T 3)、手术开始后30min(T 4)、60min(T 5)、120min(T 6)以及术毕(T 7)的SBP、DBP、MAP、HR、CO。记录术中不良事件发生次数及血管活性药使用情况。记录术中液体用量、出血量、尿量。记录术后并发症发生率、首次排气、排便时间、术后住院天数和30天全因病死率。根据肾脏疾病改善全球结果(KDIGO)指南评估AKI,术后1、2和7天测量肌酐,术后6、12和24h测量尿量。结果T 2、T 4~T 7时M组平均动脉压明显高于N组(P<0.05)。M组术中低血压持续时间、液体总量、麻黄碱用量明显低于N组(P<0.05)。M组低血压发生次数及术中低血压持续时间明显低于N组(P<0.05)。M组排气时间、排便时间明显低于N组(P<0.05)。两组患者术后住院天数和术后30天病死率差异无统计学意义。M组术后急性肾损伤发生率明显低于N组(7.5%vs 18.3%,P<0.05)。术前肌酐、术中低血压发生次数是导致术后急性肾损伤发生的共同危险因素。结论与术中持续输注0.9%氯化钠溶液比较,术中持续泵注2μg/(kg·min)甲氧明降低了老年胃肠肿瘤手术患者术后急性肾损伤的发生率,改善了患者预后。

Objective To evaluate the effect of continuous intraoperative infusion of methoxamine on renal function in elderly patients undergoing gastrointestinal tumor surgery.Methods 162 patients scheduled for elective endoscopic gastrointestinal tumor surgery,over 65 years old and ASA gradeⅠ-Ⅲ,were equally divided into 2 groups using a random number table.2min before induction of anesthesia,patients were respectively received 2μg/(kg·min)of methoxamine(M group)or volume-matched normal saline(N group).The SBP,DBP,MAP,HR and CO were recorded after entry(T 0),2min(T 1)before induction,10min(T 2)after intubation,beginning of operation(T 3),30min(T 4),60min(T 5),120min(T 6)and after operation(T 7).The number of adverse events and the use of vasoactive drugs were recorded.The amount of fluid,blood loss and urine volume during the operation were recorded.The incidence of postoperative complications,the time of first exhaust and defecation,postoperative hospital stay and 30-day all-cause mortality were recorded.AKI was assessed according to the kidney disease improvement global outcome(KDIGO)guidelines,and creatinine was measured 1 day,2days and 7days postoperatively,and urine volume was measured 6,12 and 24h postoperatively.Results In T 2,T 4-T 7,the MAP in the M group was significantly higher than that in the N group(P<0.05).The duration of intraoperative hypotension in the M group was significantly lower than that in the N group(P<0.05).There was no significant difference in postoperative hospital stay and 30-day mortality between the two groups.The incidence of postoperative AKI was lower than that in group N(M group:7.5%vs N group:18.3%,P<0.05)in preoperative creatinine intraoperative hypotension occurred frequency is the common factor of postoperative AKI.Conclusion Compared with intraoperative continuous infusion of normal saline,intraoperative continuous pumping of 2μg/(kg·min)methoxamine reduced the incidence of postoperative acute kidney injury and improved the prognosis of elderly patients undergoing gastrointestinal tumor surgery.