围术期血管活性药物目标导向输注技术的研究

Study on Target-directed Infusion of Vasoactive Drugs during General Anesthesia

目的探讨心率(heart rate,HR)和灌注指数(perfusion index,PI)作为监测导向控制血管活性药物输注的可行性。方法选择全麻后发生低血压的患者作为研究对象,根据年龄及病情分为低危组(L组,n=50)和高危组(H组,n=50)。机械通气后收缩压(systolic blood pressures,SBP)降低20%或<80 mmHg持续5 min后开始输注血管活性药物。记录入室安静后(T1)、镇静后(T2)、诱导后(T3)、气管插管后(T4)、输注血管活性药物前(T5)、术中(T6)的监测项目:SBP、HR、平均动脉血压(mean arterial pressure,MAP)、心输出量(cardic output,CO)、PI、总外周血管阻力(total peripheral resistance,TPR)等。检测术前及术毕的血浆乳酸(lactate,Lac)值。结果与L组比较,H组在T6时点的MAP差异无统计学意义,H组在术毕时的Lac值差异亦无统计学意义(P均>0.05)。与T2时点比较,T6时点L组的HR、CO降低,TPR升高(P均<0.05)。与T2时点比较,T6时点H组的CO、SV均升高(P均<0.05),HR、MAP、PI、TPR差异均无统计学意义(P均>0.05)。结论以HR和PI作为监测导向控制血管活性药物的输注速率是可行的。

Objective To explore the feasibility of HR(heart rate,HR)and PI(perfusion index,PI)as monitoring guidance to control the infusion of vasoactive drugs.Methods Patients with hypotension after general anesthesia were selected and were divided into low-risk group(group L,n=50)and high-risk group(group H,n=50)according to age and patient's condition.After mechanical ventilation during anesthesia,when SBP decreased by 20%or<80 mmHg and hypotension lasting for 5 minutes,and the vasoactive drugs began to be infused.The SBP,HR,MAP,CO,PI and TPR were recorded at entering the room(T1),after sedation(T2),after induction(T3),after tracheal intubation(T4),before transfusion of vasoactive drugs(T5)and during operation(T6).The plasma lactate(Lac)was measured before and after operation.Results Compared with group L,the MAP was not a significant change in group H at T6,and there was not a significant change of the Lac in group H at conclusion of the surgery(P all>0.05).Compared with T2,the CO、HR at T6 were all lower in group L,and the TPR at T6 was higher in group L(P all<0.05).Compared with T2,the CO,SV at T6 were all higher in group H(P all<0.05).There was not statistically significant in the HR,MAP,PI and TPR at T6 compared with T2 in group H(P all>0.05).Conclusion It is feasible to control the infusion rate of vasoactive drugs with HR and PI as monitoring guidance.