小剂量去甲肾上腺素在老年全髋关节置换术中的应用价值

Application of Low Dose Norepinephrine in Elderly Patients Undergoing Total Hip Arthroplasty

目的探讨小剂量去甲肾上腺素持续泵注在老年全髋关节置换术中的应用价值。方法回顾性分析2016年7月—2020年7月在苏州大学附属第一医院麻醉手术科行髋关节置换手术的70岁以上的老年患者278例,术中持续泵注去甲肾上腺素的患者(NE组)共有131例,术中未持续泵注去甲肾上腺素的患者(G组)共有147例。记录并比较两组患者麻醉记录单中低血压发生的次数,术中输血量、术中补液量、术中尿量、拔管时间、术后乳酸、术后血肌酐、围术期总输血量、术后不良事件发生率、住院天数等围术期指标。结果NE组术中收缩压(SBP)<100 mmHg、SBP<90 mmHg、平均动脉压(MAP)<65 mmHg的次数明显小于G组,差异有统计学意义(P<0.001)。NE组术中补液量及输血量明显小于G组,差异有统计学意义(P<0.05)。NE组围术期输血量和住院时间低于G组,差异有统计学意义(P<0.05)。结论老年全髋关节置换术中小剂量泵注去甲肾上腺素可以使血压更加平稳,改善灌注,可以减少术中及围术期输血量,降低住院时间。

Objective To evaluate the application value of low-dose norepinephrine continuous infusion in total hip arthroplasty in the elderly.Methods A retrospective analysis of 278 elderly patients(≥70 years old)who underwent hip arthroplasty in the First Affiliated Hospital of Soochow University from July 2016 to July 2020 was performed.131 patients were used continuous infusion of norepinephrine(NE group)during the operation while 147 patients(group G)were not.The occurrence of hypotension during operation,intraoperative blood transfusion volume,intraoperative fluid infusion,intraoperative urine volume,extubation time,postoperative lactic acid,postoperative creatinine,total perioperative blood transfusion volume,incidence of postoperative adverse events and hospitalization days were recorded and compared between the two groups.Results During operation,the incidences of SBP<100 mmHg,SBP<90 mmHg and MAP<65 mmHg in NE group were significantly less than those in group G(P<0.001).Intraoperative fluid infusion volume and blood transfusion volume in NE group were significantly less than those in G group(P<0.05).The perioperative blood transfusion volume and hospital stay in NE group were lower than those in G group(P<0.05).Conclusion Small dose of norepinephrine can make blood pressure more stable,improve perfusion,reduce intraoperative and perioperative blood transfusion,and reduce length of hospital stay in elderly patients with total hip arthroplasty.