去氧肾上腺素联合限制性输液在老年患者全髋关节置换术中的应用

摘要

Objective To investigate the effects of phenylephrine combined with restricted infusion on the intraoperative hemodynamics and postoperative complications in patients undergoing total hip arthroplasty.Methods A total of 60 patients hospitalized at our hospital from May 2017 to November 2017 were randomly divided into two groups (n=30):a routine infusion group (group S) and a phenylephrine combined with restricted infusion group (group NR).In group S,the patients were infused by routine methods,including cumulative missing amount,physiological requirement per hour,compensatory expansion,body fluid redistribution,blood loss.In group NR,half of total liquid loss was infused within 60 min after intravenous access was established,while constant infusion rate was then set at 4 ml ·kg-1 ·h-1.For immediate anesthesia induction,intravenous injection of 0.2 pg ·kg-1 ·min-1 phenylephrine were given.An equal volume of 6％ hydroxyethyl starch 130/0.4 sodium chloride was injected due to blood loss.The mean arterial pressure (MAP),heart rate,cardiac output (CO),cardiac index (CI),stroke volume (SV) were recorded before anesthesia induction (T0),after anesthesia induction (T1),when the operation began (T2),before cement infusion (T3),immediately when being infused (T4),3 min after infusion (T5),10 min after infusion (T6) and the operation ending (T7).Arterial blood samples were collected to test lactic value at T0 and T7.The volume and postoperative complications were recorded.Results Compared with T0,groups S and NR demonstrated significantly reduced heart rate,MAP,CO,CI,and SV at T1-T7 (P＜0.05).Compared with group S,group NR produced markedly increases in MAP,CO,CI and SV at T1,T4,and T5 (P＜0.05).There were no significant difference in heart rate between groups NR and S (P＞0.05).Compared with group S,the total fluid infusion,crystal infusion,and urine volume were lower in group NR (P＜0.05).Compared with group S,there were fewer total cases of postoperative hypertension,postoperative nausea,vomiting and postoperative complications in group NR (P＜0.05).There was no significant difference in lactate values between the two groups (P＞0.05).Conclusions Phenylephrine combined with restricted infusion is safe and effective in maintaining hemodynamic stability and reducing complications.%目的 研究去氧肾上腺素联合限制性输液对老年全髋关节置换术患者术中血流动力学及术后并发症的影响.方法 选择徐州医科大学附属医院2017年5月至2017年11月60例住院行择期单侧全髋关节置换术患者,按随机数字表法分为2组(每组30例):常规输液组(S组)和去氧肾上腺素联合限制性输液组(NR组).S组按常规方法补液,包括累计缺失量、每小时生理需要量、补偿性扩容量、体液再分布量、失血量.NR组按限制性方法补液:从建立静脉通道后60 min内以复方电解质注射液输入累计液体损失量的1/2,之后以4ml·kg-1·h-1的恒定速度输液,麻醉诱导即刻静脉泵注去氧肾上腺素0.2 μg·kg-1-min-1.2组术中失血量以等容量6％羟乙基淀粉130/0.4氯化钠注射液补充.观察并记录患者入室(T0)、麻醉诱导后(T1)、手术开始(T2)、骨水泥灌注前(T3)、灌注即刻(T4)、灌注后3 min(T5)、灌注后10 min(T6)、术毕(T7)时的心率、MAP、心排血量(cardiac output,CO)、心脏指数(cardiac index,CI)、每搏量(stroke volume,SV);于T0及T7时抽取动脉血测定乳酸值;记录术中液体出入量及术后并发症等情况. 结果 与T0比较,S组和NR组在T1～T7时的心率、MAP、CO、CI和SV明显降低(P＜0.05).与S组比较,NR组在T1、T4、T5的MAP、CO、CI、SV更高(P＜0.05).两组患者术中各时点心率比较,差异无统计学意义(P＞0.05).与S组比较,NR组的总液体输注量、晶体输注量、术中尿量更少,差异有统计学意义(P＜0.05).与S组比较,NR组术后发生高血压、恶心呕吐及术后并发症的总例数更少,差异有统计学意义(P＜0.05).两组患者术前、术毕乳酸值比较,差异无统计学意义(P＞0.05). 结论 去氧肾上腺素联合限制性输液对维持血流动力学稳定及减少并发症是安全、有效的.