术中输注米力农用于腹腔镜下结肠癌根治术老年患者的效果

Efficacy of intraoperative infusion of milrinone in elderly patients undergoing laparoscopic radical resection of colon cancer

目的观察术中输注米力农用于腹腔镜下结肠癌根治术老年患者的效果。方法拟行腹腔镜下结肠癌根治术老年患者50例,随机分为经验麻醉组(E组)和米力农组(M组),每组25例。M组在麻醉诱导前米力农负荷剂量50μg·kg^(-1)·min^(-1)输注10 min,然后术中持续输注0.6μg·kg^(-1)·min^(-1)至手术结束;E组输注同等负荷剂量的生理盐水。记录麻醉诱导前(T0)、米力农负荷剂量后30 min(T1)、60 min(T2)、90 min(T3)和手术结束(T4)时的MAP、HR、心输出量(CO)、心脏指数(CI)、PaCO_(2)、PaO_(2)、氧合指数(OI)和气道峰压(PIP),观察术后并发症发生情况。结果与E组比较,M组术中输血比例减少,尿量增加(P<0.05)。与T0时比较,T1~T4时两组MAP降低,E组CO和CI降低,M组CI升高(P<0.05)。T1~T4时,M组MAP低于E组,CO、CI高于E组(P<0.05)。与T0时比较,T2~T4时两组PaCO_(2)升高,PaO_(2)和OI降低(P<0.05),T1~T3时M组PIP升高(P<0.05)。与E组比较,T2~T4时M组PaCO_(2)降低,PaO_(2)、OI升高,T3、T4时M组PIP降低(P<0.05)。术后7 d,M组发生急性肺炎1例;E组发生肺水肿1例,急性肺炎1例。结论术中输注米力农用于腹腔镜下结肠癌根治术老年患者,可增加术中尿量,提高CO和肺顺应性,对重要器官具有保护作用。

Objective To observe the efficacy of intraoperative infusion of milrinone in elderly patients undergoing laparoscopic radical resection of colon cancer.Methods A total of 50 elderly patients undergoing laparoscopic colon cancer radical surgery were randomly divided into two groups with 25 cases each.Group M was given milrinone 50μg·kg^(-1)·min^(-1)as a loading dose for 10 minutes before anesthesia induction,which was followed by milrinone 0.6μg·kg^(-1)·min^(-1)infusion until the end of operation.Group E received the same load dose of normal saline.The indicators including MAP,HR,cardiac output(CO),cardiac index(CI),PaCO_(2),PaO_(2),oxygenation index(OI)and peak inspiratory pressure(PIP)were recorded at the time points of before anesthesia induction(T0),30 minutes(T1),60 minutes(T2),90 minutes(T3)after loading dose of milrinone,and at the end of surgery(T4).The postoperative complications were observed.Results Compared with group E,the proportion of the patients having intraoperative blood transfusion was decreased and urine volume was increased in group M(P<0.05).Compared with T0,MAP of two groups was decreased at T1 to T4,CO and CI were decreased in group E,and CI was increased in group M(P<0.05).The MAP was lower and CO and CI were higher in group M than those in group E at T1 to T4(P<0.05).Compared with T0,PaCO_(2)was increased and PaO_(2)and OI were decreased in two groups at T2 to T4,and PIP was increased in group M at T1 to T3(P<0.05).Compared with group E,PaCO_(2)was decreased and PaO_(2)and OI were increased in group M at T2 to T4,and PIP was decreased in group M at T3 and T4(P<0.05).One case occurred acute pneumonia in group M,and one case happened pulmonary edema and one case happened acute pneumonia in group E 7 days after operation.Conclusion Intraoperative infusion of milinone in elderly patients undergoing laparoscopic radical resection of colon cancer can increase intraoperative urine volume,improve CO and lung compliance,and protect vital organs.