摘要目的 比较去氧肾上腺素与去甲肾上腺素在限制性输液患者中的应用效果.方法 选取65例择期行腹腔镜下直肠切除术的患者,采用随机数字表法分为观察组(去氧肾上腺素复合限制性输液)32例和对照组(去甲肾上腺素复合限制性输液)33例.比较两组手术情况、不同时间点血流动力学指标.采集T0、T1、T2时的中心静脉血和动脉血,比较两组中心静脉血饱和度(ScvO2)、动脉血乳酸(Lac)浓度、中心静脉血氧分压(PcvO2)、PaO2、Hb浓度、静脉血氧含量(CcvO2)、动脉血氧含量(CaO2)、动静脉血氧含量差(Ca-cvO2)以及氧摄取率(ERO2).结果 观察组和对照组ASA分级(Ⅰ/Ⅱ级)分别为11例/21例、13例/20例,差异无统计学意义(x2=5.298,P=0.052);观察组、对照组患者的BMI分别为(20.61±1.65) kg/m2、(21.57±1.42) kg/m2,差异无统计学意义(t =0.652,P=1.980);观察组、对照组补液量分别为(1 162±113)mL、(1 171±104)mL,差异无统计学意义(t=1.734,P=0.065);观察组、对照组失血量分别为(276± 41) mL、(294±42) mL,差异无统计学意义(t=0.083,P=1.023);观察组、对照组尿量分别为(524±113) mL、(532±109) mL,差异无统计学意义(t=1.834,P=0.053);观察组、对照组手术时间分别为(192±24) min、(197±21) min,差异无统计学意义(=1.367,P=0.073);两组患者的MAP于T1 ～T2不断升高,两组CVP于T1时明显升高,两组的HR于T2明显升高,两组间的MAP、CVP、HR差异均无统计学意义(均P＞0.05);两组患者在T1时ScvO2、PcvO2、较T0时升高,T2时ScvO2、PcvO2、PaO2较To时明显降低;观察组Hb在T1、T2时明显降低,对照组患者的Hb浓度在T1、T2时降低,观察组低于照组,差异均有统计学意义(均P＜0.05);两组患者Lac差异无统计学意义(P＞0.05);两组不同时间点的CcvO2、CaO2、Ca-cvO2、ERO2差异均有统计学意义(均P＜0.05).结论 去氧肾上腺素较去甲肾上腺素在限制性输液患者中的应用效果更好,对组织氧代谢影响明显.

abstractsObjective To compare the effects of phenylephrine and norepinephrine in patients with restrictive transfusion.Methods 65 patients undergoing laparoscopic resection of rectal cancer were selected.According to the random number table method,the patients were randomly divided into 32 cases of observation group (phenylephrine composite restriction infusion) and 33 cases of control group(norepinephrine combined restrictive transfusion).The operation and hemodynamics of the two groups at different time points were compared.At T0,T1,T2,the central venous blood and arterial blood were collected,the central venous blood saturation (ScvO2),arterial blood lactate (Lac),central venous oxygen partial pressure (PcvO2),PaO2,Hb concentrations,venous oxygen content (CcvO2),arterial oxygen content(CaO2),arteriovenous oxygen content difference (Ca-cvO2) and oxygen uptake rate (ERO2) were compared between the two groups.Results The ASA levels (Ⅰ / Ⅱ grade) of the observation group and the control group were 11 cases/21 cases and 13 cases/20 cases,respectively,the difference was not statistically significant(x2 =5.298,P =0.052).The BMI of the observation group and the control group were (20.61 ± 1.65) kg/m2,(21.57 ± 1.42) kg/m2,respectively,the difference was not statistically significant (t =0.652,P =1.980).The fluid replacement of the observation group and the control group were (1 162 ± 113) mL,(1171 ± 104) mL,respectively,the difference was not statistically significant (t =1.734,P =0.065).The blood loss of the observation group and the control group were (276 ± 41) mL,(294 ± 42) mL,respectively,the difference was not statistically significant (t =0.083,P =1.023).The urine volume of the observation group and the control group were (524 ± 113) mL,(532 ± 109) mL,respectively,the difference was not statistically significant(t =1.834,P =0.053).The operation time of the observation group and the control group were (192 ± 24) min,(197 ± 21) min,respectively,the difference was not statistically significant(t =1.367,P =0.073).The MAP at T1-T2 of the two groups increased,the CVP of the two groups was significantly higher at T1,the HR of the two groups was significantly higher at T2.The MAP,CVP,HR between the two groups had no significant differences (all P ＞ 0.05).The levels of ScvO2,PcvO2 and PaO2 at T1 were significantly higher than those at T0,on the contrary,the levels of ScvO2,PcvO2 and PaO2 at T2 were significantly lower than those at T0,and the Hb in the observation group was significantly lower at T1-T2,the Hb in the control group was significantly lower at T,-T2,which in the observation group was lower than the control group,the differences were statistically significant(all P ＜ 0.05).There was no statistically significant difference in Lac between the two groups (P ＞ 0.05).There were statistically significant differences in CcvO2,CaO2,Ca-cvO2 and ERO2 between the two groups at different time points (all P ＜ 0.05).Conclusion Phenylephrine is more effective than norepinephrine in limiting infusion in elderly patients,and it has more obvious effects on tissue oxygen metabolism.