胃癌根治术患者给予磷酸肌酸钠氯化钠注射液预处理的临床观察

Clinical Observation of Pretreatment with Sodium Creatine Phosphate Injection in Patients with Radical Gastrectomy

目的:研究胃癌根治术患者给予磷酸肌酸钠氯化钠注射液预处理的临床效果。方法:我院75例行胃癌根治术的患者随机分为观察组和对照组,手术麻醉前观察组患者给予磷酸肌酸钠2 g溶入0. 9%氯化钠注射液100 ml中静滴进行预处理,对照组给予等量氯化钠注射液。在手术过程不同时段抽取两组患者静脉血,测定血糖(BG)、胰岛素(IOB)、胰高血糖素(GCG)、皮质醇值(COL);比较两组患者不同时段血压(MAP)、心排血量(CO)、每搏输出量(SV)、左心室舒张末期容积(LVEDV)水平变化,以及两组患者药品不良反应发生情况。结果:观察组总有效率明显高于对照组(P <0. 05)。手术过程中两组患者血糖均有升高但对照组处于更高状态(P <0. 05); IOB水平先下降然后逐渐升高直到拔管后再逐渐降低,COL与GCG均有不同程度的升高,观察组低于对照组(P <0. 05)。手术过程中对照组血压一直处于升高状态,观察组血压低于对照组且在正常范围内(P <0. 05),观察组在气管插管时、开腹时以及手术结束时CO、SV明显高于对照组(P <0. 05),而在手术结束时LVEDV明显低于对照组(P <0. 05)。结论:对于进行胃癌根治术患者,术前使用磷酸肌酸钠预处理能使应激性高血糖反应风险降低,并且能改善患者术中循环功能,使血压处于平稳状态,有利于预后。

Objective: To clinically observe the pretreatment with sodium creatine phosphate injection in patients with radical gastrectomy. Methods: Seventy-five patients scheduled to undergo radical gastrectomy were randomly divided into the observation group and the control group. Before the operation anesthesia,the observation group was pretreated with intravenous infusion of 2 g sodium creatine phosphate injection dissolved in 100 ml 0. 9% sodium chloride infusion,the same amount of 0. 9% sodium chloride infusion was pretreated in the control group,and the other treatments were the same in both groups. Venous blood was collected from the two groups at the same time point to measure blood glucose,insulin,glucagon and cortisol values. The mean artery pressure (MAP),cardiac output (CO),stroke volume (SV) and left ventricular end-diastolic volume (LVEDV) of the two groups were recorded and compared. Results: After the treatment,the total effective rate of the observation group was significantly higher than that of the control group. During the operation,the blood glucose of both groups increased,and the control group was in a higher state (P < 0. 05). The level of IOB decreased at first and then gradually increased until it was gradually reduced after extubation. COL and GCG had different degrees of elevation,and those in the observation group were lower than those in the control group (P < 0. 05). During the operation,the blood pressure of the control group was always elevated. The blood pressure of the observation group was lower than that of the control group and within the normal range (P < 0. 05). The CO and SV were obvious in the observation group during tracheal intubation and laparotomy and at the end of surgery,which were higher than those in the control group (P < 0. 05),and LVEDV was significantly lower than that in the control group at the end of surgery (P < 0. 05). Conclusion: For patients undergoing radical gastrectomy,preoperative use of sodium creatine phosphate injection can reduce the risk of stress hyperglycemia,improve patients’ intraoperative circulatory function and keep blood pressure stable,which is beneficial to prognosis.