去甲肾上腺素对全身麻醉患者氧耗的影响

The changes in oxygen consumption induced by noradrenaline during the general anesthesia

目的观察在氧供(DO_(2))充足情况下,去甲肾上腺素对全身麻醉患者氧耗(VO_(2))的影响。方法前瞻性纳入2021年1月至2月首都医科大学附属北京友谊医院收治的36例美国麻醉医师协会(ASA)分级I~II级,择期行全身麻醉下腹腔镜结肠癌根治术患者。手术前1 d置入锁骨下静脉导管,麻醉诱导前行桡动脉穿刺置管,连接连续心排量系统。麻醉维持1 h后,记录基础值(T_(0))的平均动脉压(MAP)、心率、心输出量(CO)等资料;抽取中心静脉与动脉血样,行血气分析,测定血样中T_(0)、去甲肾上腺素5μg给药后2 min(T_(2))、10 min(T_(10))的动、静脉氧分压(PaO_(2),PvO_(2)),动、静脉血氧饱和度(SaO_(2),SvO_(2))及血红蛋白(Hb)值。根据各时间点的血气结果计算DO_(2)、VO_(2)数值。结果与T_(0)比较,T_(2)时患者的VO_(2)显著性降低,差异有统计学意义(P<0.001);T_(10)时恢复至基础水平,但仍较T_(2)时明显升高,差异有统计学意义(P<0.05)。与T_(0)比较,T_(2)时患者的PvO_(2)显著升高,差异有统计学意义(P<0.05),T_(10)时恢复至基础水平。与T_(0)比较,T_(2)时患者的DO_(2)无显著改变,T_(10)时较T_(0)时显著升高,差异有统计学意义(P<0.05)。CO在T_(0)、T_(2)、T_(10)时无显著性改变,差异无统计学意义(P>0.05)。与T_(0)比较,T_(2)、T_(10)时患者的MAP显著升高,差异均有统计学意义(P<0.05)。与T_(0)比较,T_(2)时患者的心率有所降低,差异有统计学意义(P<0.05)。结论全身麻醉下,氧供充足时,单次给予去甲肾上腺素5μg能显著性降低VO_(2)。

Objective To observe the changes of oxygen consumption(VO_(2))after the injection of noradrenaline in patients with sufficient oxygen supply(DO_(2))during the general anesthesia.Methods From January to February 2021,36 patients of American Society of Anesthesiologists(ASA)grades I to II undergoing elective laparocolectomy under general anesthesia were selected prospectively from Beijing Friendship Hospital,Capital Medical University.Central venous catheter was placed before the operation.Invasive radial pressure monitoring was established before anesthesia induction and connected with a continuous cardiac output monitoring system.After anesthesia was maintained for 1 hour,the basic value(T_(0))of mean arterial pressure(MAP),heart rate,cardiac output(CO)and other data were recorded.Central venous and arterial blood samples were drawn,and blood gas analysis was performed.In the blood samples,the arterial and venous partial pressure of oxygen(PaO_(2),PvO_(2)),arterial and venous oxygen saturation(SaO_(2),SvO_(2))and hemoglobin(Hb)values of the blood sample at T_(0) and norepinephrine 5μg after administration of 2 min(T_(2))and 10 min(T_(10))were measured.Blood gas analysis were performed and the values of global VO_(2) were calculated according to the Fick formula.Results Compared with T_(0),the patient's VO_(2) at T_(2) was significantly reduced,and the difference was statistically significant(P<0.001);at T_(10),it returned to the basic level,but it was still significantly higher than that at T_(2),and the difference was statistically significant(P<0.05).Compared with T_(0),the patient's PvO_(2) was significantly increased at T_(2),the difference was statistically significant(P<0.05),and it returned to the basic level at T_(10).Compared with T_(0),the patient's DO_(2) at T2 did not change significantly,and it was significantly higher at T_(10) than that at T_(0),and the difference was statistically significant(P<0.05).There was no significant change in CO at T_(0),T_(2),and T_(10),and the difference was not statistically significant(P>0.05).Compared with T_(0),the MAP of patients at T_(2) and T_(10) increased significantly,and the difference was statistically significant(P<0.05).Compared with T_(0),the patient's heart rate decreased at T_(2),and the difference was statistically significant(P<0.05).Conclusion Noradrenaline 5μg decrease the global oxygen consumption with sufficient oxygen supply during the general anesthesia.