摘要
目的 观察急性等容血液稀释(ANH)对靶控输注(TCI)依托咪酯血药浓度和肾上腺皮质功能的影响.方法 选择多节段脊柱手术患者60例,男35例,女 25 例,年龄 30～60 岁,BMI 20～25 kg/m2,ASAⅠ或Ⅱ级.采用随机数字表法将患者分为两组:ANH组和对照组,每组30 例.TCI依托咪酯麻醉诱导和麻醉维持.ANH组麻醉诱导平稳后行ANH,理想Hct 28%～30%,术后1h内回输完毕;对照组常规处理.记录依托咪酯用量.采用液相色谱-串联质谱(LC-MS/MS)法检测两组术毕即刻、术后 10、20、30 min的依托咪酯血药浓度和ANH组自体血采集入储血袋即刻、在储血袋保存1h、回输即刻的依托咪酯血药浓度.采用化学发光免疫分析(CLIA)法检测麻醉诱导前、术毕即刻、术后 1、2 d的血浆皮质醇(Cor)、促肾上腺皮质激素(ACTH)和醛固酮(ALD)浓度.结果 两组依托咪酯用量差异无统计学意义.与术毕即刻比较,术后 10、20 和 30 min两组依托咪酯血药浓度明显降低(P＜0.05).与对照组比较,术后 10 min ANH组依托咪酯血药浓度明显升高(P＜0.05).ANH组自体血采集入储血袋即刻、在储血袋保存 1h和回输即刻依托咪酯血药浓度分别为(547.8±119.4)、(536.7±107.8)、(522.8±91.7)ng/ml.与麻醉诱导前比较,术毕即刻两组Cor、ALD浓度明显降低(P＜0.05),ACTH浓度明显升高(P＜0.05),麻醉诱导前和术后 1、2 d两组Cor、ALD和ACTH浓度差异无统计学意义.结论 ANH用于TCI依托咪酯的骨科手术中,采集的自体血回输后仅短暂(10 min左右)增加依托咪酯的血药浓度,肾上腺皮质功能在术后 24h 内恢复到麻醉诱导前水平.
Abstract
Objective To observe the effects of acute normovolemic hemodilution(ANH)on target-controlled infusion(TCI)of etomidate blood drug concentration and adrenal cortical function.Methods Sixty patients who undergo elective multisegmental spine surgery,35 males and 25 females,aged 30-60 years,BMI 20-25 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups using random number table method:ANH group and control group,30 patients in each group.Both groups used a target-controlled infusion of etomidate for anesthesia induction and anesthesia maintenance.In the ANH group,ANH was performed after steady anesthesia induction,ideal Hct 28％to 30％,and transfused within 1 hour after surgery;the control group was routinely treated.The dosage of etomidate was recorded.Liquid chroma-tography-tandem mass spectrometry(LC-MS/MS)was used to detect etomidate blood concentrations at the immediate postoperative,10,20,and 30 minutes postoperative periods in the two groups,and the immedi-ate moment autologous blood collected into the storage bag,preserved in the storage bag for 1 hour,and the immediate moment transfused back in the ANH group.Plasma concentrations of cortisol(Cor),adrenocorti-cotropic hormone(ACTH),and aldosterone(ALD)were measured by chemiluminescence immunoassay(CLIA)before the induction of anesthesia,immediately after the operation,and at 1 day and 2 days postop-eratively.Results There was no significant difference in the total dosage of etomidate between the two groups.Compared with the immediate postoperative period,the plasma etomidate concentration was signifi-cantly decreased 10,20,and 30 minutes after surgery(P<0.05).Compared with the control group,the concentration increased significantly 10 minutes after surgery in the ANH group(P<0.05).The plasma concentrations of etomidate were(547.8±119.4)ng/ml at the immediate moment autologous blood collected into the storage bag,(536.7±107.8)ng/ml at the preserved in the storage bag for 1 hour,and(522.8±91.7)ng/ml at theimmediatemoment transfusedbackinthe ANHgroup.Comparedwithbeforein-duction of anesthesia,the concentration of Cor and ALD immediately after the operation decreased signifi-cantly(P<0.05)and the concentration of ACTH was significantly higher(P<0.05).There were no sta-tistically significant differences in the concentrations of Cor,ALD,and ACTH between the two groups before induction of anesthesia 1 day and 2 days postoperatively.Conclusion In the orthopedic surgery of TCI eto-midate,return transfusion of collected autologous blood transiently(about 10 minutes)increases etomidate blood concentrations,the function of adrenal cortical will recover to the preoperative level within 24 hours after the operation.
基金项目
上海市卫生健康委员会科研项目(202040474)
上海市浦东新区卫生系统重点学科群建设项目(PWZxq2022-05)
维普
万方数据