α1肾上腺素受体激动剂在全身麻醉妇科腹腔镜手术中应用效果

Effect ofα1 adrenergic receptor agonist in gynecological laparoscopic surgery patients under general anesthesia

目的目前临床上常用乳酸林格氏液来全麻期间纠正低血压及维持正常血容量,然而却增加了术后组织水肿的风险,而α1肾上腺素受体激动剂可以在维持血压及心率稳定的同时,降低术后组织水肿风险,本研究探讨α1肾上腺素受体激动剂在全身麻醉下妇科腹腔镜手术中的应用效果。方法选取本院2018-2019年行妇科腹腔镜手术的全身麻醉患者为研究对象,采用组间年龄、性别、体质量和身高均衡的原则,选择观察组与对照组,各80例。对照组患者行全身麻醉下妇科腹腔镜手术,观察组在对照组基础上加用α1肾上腺素受体激动剂,比较两组各时段的平均动脉压、心率、尿液累积量及尿液形成速率变化。结果术中5min,观察组心率为(75.42±8.63)次/min,高于对照组的(72.41±8.27)次/min,t=3.084,P=0.002;术中30min,观察组心率为(77.54±8.49)次/min,高于对照组的(75.69±7.63)次/min,t=1.985,P=0.048;术毕,观察组心率为(75.24±6.42)次/min,高于对照组的(72.42±8.16)次/min,t=3.327,P=0.001。术中5min,观察组平均动脉压为(86.49±8.64)mm Hg,高于对照组的(81.52±8.14)mm Hg,t=5.128,P<0.001;术中30min,观察组平均动脉压为(84.82±7.94)mm Hg,高于对照组的(78.42±7.68)mm Hg,t=7.096,P<0.001;术毕,观察组平均动脉压为(85.74±7.58)mm Hg,高于对照组的(82.46±8.57)mm Hg,t=3.511,P=0.001。补液20min,观察组尿液累积量为(16.52±4.63)mL,多于对照组的(11.47±3.58)mL,t=10.568,P<0.001;补液40min,观察组尿液累积量为(48.72±8.64)mL,多于对照组的(20.55±7.61)mL,t=19.966,P<0.001;补液60min,观察组尿液累积量为(84.13±9.42)mL,多于对照组的(38.59±8.53)mL,t=43.889,P<0.001。补液20min,观察组尿液形成速率为(1.06±0.23)mL/min,快于对照组的(0.75±0.14)mL/min,t=14.101,P<0.001;补液40min,观察组尿液形成速率为(1.43±0.35)mL/min,快于对照组的(0.71±0.19)mL/min,t=22.143,P<0.001;补液60min,观察组尿液形成速率为(1.56±0.41)mL/min,快于对照组的(0.79±0.16)mL/min,t=21.428,P<0.001。结论α1肾上腺素受体激动剂在全身麻醉下妇科腹腔镜手术患者中应用效果较好,可以有效维持平均动脉压及心率稳定,且可以促进机体内液体经尿液排泄。

OBJECTIVE At present,lactated Ringer’s solution is commonly used in clinic to correct hypotension and maintain normal blood volume during general anesthesia,but it increases the risk of postoperative tissue edema,andα1 adrenergic receptor agonists can maintain blood pressure and stable heart rate.At the same time,the risk of postoperative tissue edema is reduced.This study investigated the effect ofα1 adrenergic receptor agonists in patients undergoing gynecological laparoscopy under general anesthesia.METHODS Taking the general anesthesia patients who underwent gynecological laparoscopic surgery in our hospital from 2018 to 2019 as the research object,the principle of balanced age,sex,weight and height between the groups was used to select the observation group and the control group,80 cases in each group.Patients in the control group underwent gynecological laparoscopy under general anesthesia.The observation group was treated withα1 adrenergic receptor agonist on the basis of the control group.The mean arterial pressure,heart rate,urine accumulation,and urine formation rate were compared between the two groups.RESULTS At 5 min during the operation,the heart rate in the observation group was(75.42±8.63)beats/min during the operation,which was higher than(72.41±8.27)beats/min in the control group,t=3.084,P=0.002.At 30 minutes during the surgery,the heart rate in the observation group was(77.54±8.49)beats/min,higher than the control group(75.69±7.63)beats/min,t=1.985,P=0.048.After surgery,the heart rate of the observation group was(75.24±6.42)beats/min,which was higher than the control group(72.42±8.16)beats/min,t=3.327,P=0.001.The mean arterial pressure in the observation group was(86.49±8.64)mm Hg at 5 minutes during the operation,which was higher than(81.52±8.14)mm Hg in the control group,t=5.128,P<0.001.The mean arterial pressure in the observation group at 30 minutes during the operation was(84.82±7.94)mm Hg,which was higher than(78.42±7.68)mm Hg in the control group,t=7.096,P<0.001.After surgery,the mean arterial pressure in the observation group was(85.74±7.58)mm Hg,which was higher than the control group(82.46±8.57)mm Hg,t=3.511,P=0.001.After 20 minutes of fluid replacement,the urine accumulation in the observation group was(16.52±4.63)ml,which was more than that in the control group(11.47±3.58)ml,t=10.568,P<0.001.At 40 minutes after fluid replacement,the urine accumulation in the observation group was(48.72±8.64)ml,more than(20.55±7.61)ml of the control group,t=19.966,P<0.001.At 60 minutes after fluid replacement,the urine accumulation of the observation group was(84.13±9.42)ml,which was more than(38.59±8.53)ml,t=43.889,P<0.001.The rate of urinary formation in the observation group was(1.06±0.23)ml/min after rehydration for 20 min,faster than(0.75±0.14)ml/min in the control group,t=14.101,P<0.001.For 40 min,the urine formation rate in the observation group was(1.43±0.35)ml/min,which was faster than the control group(0.71±0.19)ml/min,t=22.143,P<0.001.60 minutes after fluid replacement,the urine formation rate in the observation group was(1.56±0.41)ml/min,faster than(0.79±0.16)ml/min in the control group,t=21.428,P<0.001.CONCLUSIONSα1 adrenergic receptor agonist is effective in gynecological laparoscopic surgery patients under general anesthesia.It can effectively maintain average arterial pressure and stable heart rate,and can promote the excretion of fluid from the body through urine.