血液稀释联合硝酸甘油对腹腔镜亲属捐肾者全身氧合的影响

摘要

Objective:To investigate the effects of hemodilution combined nitroglycerin on systemic oxygenation in relative donor undergoing laparoscopic nephrectomy.Methods:Thirty healthy donors,aged 19-55 y,weighing 42-62 kg,scheduled for laparoscopic nephrectomy under pneumoperitoneum,were randomly divided into 2 groups:experimental group (group S,n =15) and control group (group C,n =15).Two groups were performed with modified 4％ fluid gelatin (MFG) and Lactated Ringer's solution (LR) (MFG:LR =1:1) infusion from 15 min before anesthesia induction to stopping renal artery,goal hemocrit (HCT) was 35％.In group S,nitroglycerin was transfused by micro pump at the dosage of 1.5-2 μg·kg-1·min-1 at beginning,to maintain mean arterial pressure (MAP) in the basic value plus or minus 25％ range.In both groups,end-expiratory pressure of carbon dioxide was maintained in 35-40 mmHg range,and CO2 inflation pressure was 10-13 mmHg.HCT,CO,SaO2,DO2,VO2,Lac,PgCO2,Pg-aCO2 and hemodynamics parameters,blood gas analysis data were measured and recorded before anesthesia induction (To),l0 min after anesthesia (T1),at the pneumoperitoneum beginning (T2),after 30 min (T3),during blocking renal artery (T4) and at end of operation (T5).Liquid quantity,anesthesia time,operation time,liquid filling time and intraoperative anesthetic drugs,nitroglycerin consumption,etc,were recorded at T5.Results:There was no significant difference in liquid quantity,anesthesia time,operation time,liquid filling time,intraoperative anesthetic drugs and HCT,VO2 at different time points (P ＞ 0.05).MAP and HR were higher at T2-T4,DO2 and CO were lower at T2 and higher at T4 in both groups than that at TO (P ＜ 0.05).Lac and Pg-aCO2 gradually rose at T2-T3 in group C (P ＜ 0.05).Compared with group C,MAP,HR and CVP were lower at T2.4,DO2 and CO were higher at T2,T4,Lac and Pg-aCO2 were lower at T2-T3 in group S (P ＜ 0.05).Conclusions:In laparoscopic nephrectomy with pneumoperitoneum,implementing mild hemodilution combined nitroglycerin,is not only safe to relative kidney donator,but can also sustain whole body oxygen metabolism and oxygenated visceral stability without activating anaerobic metabolism.%目的:观察血液稀释联合硝酸甘油对腹腔镜亲属捐肾者全身氧合的影响.方法:选择行气腹腹腔镜肾脏切除术的健康亲属捐肾者30例,随机分为实验组(S组,n=15)与对照组(C组,n=15).麻醉诱导前15 min至肾动脉阻断时两组连续输注4％琥珀酰明胶(MFG)及乳酸林格氏液(LR)(MFG:LR=1:1),目标血液稀释值红细胞压积(HCT)为35％.S组同时应用微量泵输注硝酸甘油,初始量为1.5～2tμg· kg-1· min-1,维持平均动脉压(MAP)在基础值±25％之内.两组呼气末二氧化碳分压(PETCO2)维持在35 ～ 40 mmHg; CO2气腹压力维持在10 ～ 13 mmHg.于诱导前(To)、麻醉平稳后10 min(T1)、气腹时(T2)、气腹后30 min(T3)、肾动脉阻断时(T4)及手术结束时(T5)测定两组患者SaO2、HCT、CO、Lac、胃黏膜PgCO2及血气分析、血流动力学参数等,计算DO2、VO2、Pg-aCO2的变化,并记录术毕液体出入量、麻醉时间、手术时间、液体灌注时间及术中麻醉药物、硝酸甘油用量等.结果:两组液体出入量、麻醉时间、手术时间、液体灌注时间、术中麻醉药物及不同时间点HCT、VO2等指标差异无统计学意义(P＞0.05).与To相比,两组供肾者T2～ T4时MAP、HR显著升高(P ＜0.05);T2时两组D02、CO均降低,T4时均升高(P＜0.05)；C组供肾者T2、T3时Lac、Pg-aCO2有升高趋势(P＜0.05).与C组相比,S组T2～T4时MAP、HR、CVP显著降低,T2、T4时DO2、CO升高明显,T2、T3时Lac、Pg-aCO2降低(P＜0.05).结论:气腹腹腔镜肾脏切除术中行轻度血液稀释联合硝酸甘油,对亲属捐肾者安全性较高,而且其全身氧代谢稳定,内脏氧合良好,未见启动无氧代谢状态.