米力农控制性低中心静脉压对腹腔镜肝切除术患者术中脑血流的影响
Effect of milrinone-induced controlled low central venous pressure on intraoperative cerebral blood flow in patients undergoing laparoscopic hepatectomy
董育硕 1崔佳丽 2高巨 1张婷婷 1李琳 1葛亚丽2
作者信息
- 1. 扬州大学附属苏北人民医院麻醉科,扬州 225001
- 2. 徐州医科大学扬州临床学院,扬州 225001
- 折叠
摘要
目的 评价米力农控制性低中心静脉压(CLCVP)对腹腔镜肝切除术患者术中脑血流的影响.方法 择期行腹腔镜肝切除术患者80例,性别不限,BMI 18～30 kg/m2,年龄18～64岁,ASA分级Ⅰ-Ⅲ级,采用随机数字表法分为2组(n=40):硝酸甘油组(X组)和米力农组(M组).手术开始后M组持续静脉泵注米力农0.5 μg·kg-1·min-1,X组持续静脉泵注硝酸甘油0.5～1.5 μg·kg-1·min-1,维持 CVP＜5 cmH2O.术中静脉泵注去甲肾上腺素 0.01～0.10 μg·kg-1·min-1维持MAP 60～90 mmHg,必要时静脉注射去甲肾上腺素8～16μg.分别于气管插管后10 min(T1)、气腹建立后(T2)、CVP达目标值后5和30 min(T3和T4)、CVP恢复正常值后5 min(T5)和术毕(T6)记录左侧颈内动脉平均血流速度(IBVm)、颈内动脉分钟血流量(IBF)、CO和CI.记录术野评分、术中去甲肾上腺素用量、液体出入量和术后7 d内不良反应发生情况.结果 与X组比较,M组T3-5时CO、CI、IBVm和IBF升高,术中去甲肾上腺素用量减少,术野评分升高(P＜0.05);2组各时点术中液体出入量和术后不良反应发生率差异无统计学意义(P＞0.05).结论 相对于硝酸甘油CLCVP而言,米力农CLCVP可在一定程度上改善腹腔镜肝切除术患者术中脑血流降低.
Abstract
Objective To evaluate the effect of controlled low central venous pressure(CLCVP)in-duced by milrinone on intraoperative cerebral blood flow in the patients undergoing laparoscopic hepatectomy.Methods Eighty American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients,regard-less of gender,scheduled for elective laparoscopic hepatectomy,with body mass index of 18-30 kg/m2,aged 18-64 yr,were divided into 2 groups(n=40 each)by a random number table method:nitroglycerin group(X group)and milrinone group(M group).After the start of surgery,milrinone 0.5 μg·kg-1·min-1 was continuously infused in group M and nitroglycerin 0.5-1.5 μg·kg-1·min-1 was continuously infused in group X to maintain central venous pressure(CVP)＜5 cmH20.Norepinephrine 0.01-0.10 μg·kg-1·min-1 was intravenously injected during operation to maintain mean arterial pressure at 60-90 mmHg.Norepinephrine 8-16 μg was intravenously injected when necessary.At 10 min after tracheal intubation(T,),after estab-lishment of pneumoperitoneum(T2),at 5 and 30 min after CVP reached the target value(T3,T4),at 5 min after CVP returned to normal value(T5)and at the end of surgery(T6),the internal carotid artery mean blood flow velocity,internal carotid artery blood flow,cardiac output,and cardiac index were recorded.The surgical field score,consumption of intraoperative norepinephrine,fluid input and output,and occurrence of adverse reactions at 7 days after operation were recorded.Results Compared with group X,the cardiac output,cardiac index,internal carotid artery mean blood flow velocity and internal carotid artery blood flow were significantly increased,the consumption of intraoperative norepinephrine was decreased,and the surgical field score was increased at T3-5 in group M(P＜0.05).There was no significant difference in the intraopera-tive fluid intake and output and incidence of postoperative adverse reactions at each time point between the 2 groups(P＞0.05).Conclusions Compared with nitroglycerin-induced CLCVP,milrinone-induced CLCVP can improve the reduction in intraoperative cerebral blood flow in the patients undergoing laparoscopic hepa-tectomy to some extent.
关键词
米力农/降压,控制性/中心静脉压/肝切除术/脑血管循环Key words
Milrinone/Hypotension,controlled/Central venous pressure/Hepatectomy/Cerebrovascular circulation引用本文复制引用
基金项目
江苏省青年医学重点人才项目(QNRC2016337)
出版年
2024
NETL
NSTL
万方数据