不同剂量甲氧明联合限制性输液对老年胸腔镜肺叶切除术的影响

李吉梅; 向梅; 易强林; 莫怀忠

doi:10.11659/jjssx.09E023031

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不同剂量甲氧明联合限制性输液对老年胸腔镜肺叶切除术的影响

临床研究 | 更新时间：2024-12-10

- 不同剂量甲氧明联合限制性输液对老年胸腔镜肺叶切除术的影响
- Effects of different doses of methoxamine combined with restricted fluid infusion in elderly patients undergoing thoracoscopic lobectomy
- 局解手术学杂志 2024年33卷第12期页码：1057-1061
- 作者机构：
  
  1.贵州医科大学麻醉学院，贵州贵阳 550004
  2.贵州省人民医院麻醉科，贵州贵阳 550000
  3.贵州医科大学附属医院麻醉科，贵州贵阳550004
  4.贵州医科大学附属肿瘤医院麻醉科，贵州贵阳 550004
- 作者简介：
  
  莫怀忠，E-mail：1982629307@qq.com
- 基金信息：
  
  贵州省卫生健康委员会基金(2021XMSB000332352)
- DOI：10.11659/jjssx.09E023031
  中图分类号： R614
- 纸质出版日期：2024-12-25，
  
  收稿日期：2023-09-07，
- 稿件说明：
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李吉梅,向梅,易强林等.不同剂量甲氧明联合限制性输液对老年胸腔镜肺叶切除术的影响[J].局解手术学杂志,2024,33(12):1057-1061.

LI Ji-mei,XIANG Mei,YI Qiang-lin,et al.Effects of different doses of methoxamine combined with restricted fluid infusion in elderly patients undergoing thoracoscopic lobectomy[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(12):1057-1061.
李吉梅,向梅,易强林等.不同剂量甲氧明联合限制性输液对老年胸腔镜肺叶切除术的影响[J].局解手术学杂志,2024,33(12):1057-1061. DOI： 10.11659/jjssx.09E023031.

LI Ji-mei,XIANG Mei,YI Qiang-lin,et al.Effects of different doses of methoxamine combined with restricted fluid infusion in elderly patients undergoing thoracoscopic lobectomy[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(12):1057-1061. DOI： 10.11659/jjssx.09E023031.

摘要

目的

分析不同剂量甲氧明联合限制性输液对老年胸腔镜肺叶切除术的影响。

方法

纳入拟行胸腔镜肺叶切除术的老年患者120例，按随机数字表法分为对照组(C组)、2 μg·kg

-1

·min

-1

甲氧明组（M

组）、3 μ·kg

-1

·min

-1

甲氧明组（M

组）和4 μg·kg

-1

·min

-1

甲氧明组(M

组)。对比患者麻醉前（

T0）、麻醉诱导后（T1）、单肺通气前（T2）、单肺通气5 min（T3）、肺叶切除后即刻（T4）、单肺通气结束后（T5）、平卧位后（T6）的平均动脉压(MAP)、心率、中心静脉压(CVP)及脉压变异率（PPV)。比较各组患者T0和T6时的乳酸值与氧合指数。记录各组患者术中晶体量、胶体量、尿量、失血量。统计术中高血压、低血压、心动过速、心动过缓、肺水肿、低氧血症，以及术后7 d内肺部感染、肺不张和急性肾损伤等并发症发生率。

结果

与C组比较，在T1时，M

、M

组患者MAP和CVP明显升高（

0.05），M

、M

组患者PPV明显降低（

0.05），M

组患者心率明显降低（

0.05）。T0时C组与其他3组患者的氧合指数和乳酸值无显著差异（

0.05），T6时M

组患者氧合指数明显高于C组和M

组（

0.05），T6时M

组患者乳酸值明显高于M

组（

0.05）。与C组比较，另3组患者胶体量和晶体量明显减少（

0.05）。与C组相比，M

组患者术中高血压和心动过缓发生率明显升高（

0.05），M

、M

组患者术中低血压发生率明显降低（

0.05）。4组术后并发症发生率比较，差异无统计学意义（

0.05）。

结论

3 μg·kg

-1

·min

-1

甲氧明联合限制性输液应用于老年胸腔镜肺叶切除术中可维持血流动力学稳定，保证良好的组织灌注，是一种可以安全应用于老年患者的循环管理方案。

Abstract

Objective

To analyze the effects of different doses of methoxamine combined with restricted fluid infusion in elderly patients undergoing thoracoscopic lobectomy.

Methods

A total of 120 elderly patients undergoing thoracoscopic lobectomy were included and divided into control group （group C），2 μg·kg

-1

·min

-1

methoxamine group （M

group），3 μg·kg

-1

·min

-1

methoxyamine group （M

group） and 4 μg·kg

-1

·min

-1

methoxamine group （M

group） according to random number table. The mean arterial pressure （MAP）， heart rate， central venous pressure （CVP） and pulse pressure variation （PPV） of patients before anesthesia （T0），after anesthesia induction （T1），before one-lung ventilation （T2），after one-lung ventilation for 5 minutes （T3），immediately after lobectomy （T4），after one-lung ventilation （T5） and af

ter supine position （T6） were compared. The lactic acid value and oxygenation index of patients at T0 and T6 in each group were compared. The amount of crystal，colloid，urine and blood loss of patients in each group were recorded. The incidence of complications such as hypertension，hypotension，tachycardia，bradycardia，pulmonary edema and hypoxemia during operation，and pulmonary infection，atelectasis and acute kidney injury within 7 days after operation were counted.

Results

Compared with group C， MAP and CVP at T1 of patients in M

group and M

group significantly increased（P

0.05），PPV at T1 of patients in M

group and M

group significantly decreased （P

0.05），while heart rate of patients in M

group significantly decreased （P

0.05）. There was no significant difference in oxygenation index or lactic acid value at T0 of patients between group C and other groups （P

0.05）， oxygenation index at T6 of patients in M

group was significantly higher than those in group C and M

group （P

0.05），lactic acid value at T6 of patients in M

group was significantly higher than that in M

group （P

0.05）. Compared with group C，the dosage of colloid and crystal in other three groups significantly decreased （P

0.05）. Compared with group C，the incidence of hypertension and bradycardia in M

group significantly increased （P

0.05），while the incidence of hypotension in M

group and M

group significantly decreased （P

0.05）. There was no significant difference in the incidence of postoperative complications between the four groups （P

0.05）.

Conclusion

The application of 3 μg·kg

-1

·min

-1

methoxamine combined with restricted fluid infusion in thoracoscopic lobectomy for elderly patients can maintain hemodynamic stability and ensure good tissue perfusion，which is a safe circulation management strategy

for elderly patients.

关键词

甲氧明限制性输液胸腔镜肺叶切除术老年血流动力学

Keywords

methoxaminerestricted fluid infusionthoracoscopic lobectomyelderlyhemodynamics

references

Kim HK. Video-assisted thoracic surgery lobectomy［J］. J Chest Surg，2021，54（4）：239-245.doi：10.5090/jcs.21.061http://dx.doi.org/10.5090/jcs.21.061.

Batchelor TJP，Rasburn NJ，Abdelnour-Berchtold E，et al. Guidelines for enhanced recovery after lung surgery： recommendations of the Enhanced Recovery After Surgery （ERAS®） Society and the European Society of Thoracic Surgeons （ESTS）［J］. Eur J Cardiothorac Surg，2019，55（1）：91-115.doi：10.1093/ejcts/ezy301http://dx.doi.org/10.1093/ejcts/ezy301.

Guo X，Hu J，Xiao H，et al. Effect of continuous intraoperative infusion of methoxamine on renal function in elderly patients undergoing gastrointestinal tumor surgery： a randomized controlled trial［J］. BMC Anesthesiol，2020，20（1）：148.doi：10.1186/s12871-020-01064-0http://dx.doi.org/10.1186/s12871-020-01064-0.

俞卫锋，王天龙，郭向阳，等. α1肾上腺素能受体激动剂围术期应用专家共识（2017版）［J］. 临床麻醉学杂志，2017，33（2）：186-192.doi：10.3969/j.issn.1004-5805.2017.02.022http://dx.doi.org/10.3969/j.issn.1004-5805.2017.02.022.

Vernooij LM，van Klei WA，Machina M，et al. Different methods of modelling intraoperative hypotension and their association with postoperative complications in patients undergoing non-cardiac surgery［J］. Br J Anaesth，2018，120（5）：1080-1089.doi：10.1016/j.bja.2018. 01.033http://dx.doi.org/10.1016/j.bja.2018.01.033.

Salmasi V，Maheshwari K，Yang D，et al. Relationship between intraoperative hypotension，defined by either reduction from baseline or absolute thresholds，and acute kidney and myocardial injury after noncardiac surgery： a retrospective cohort analysis［J］. Anesthesiology，2017，126（1）：47-65.doi：10.1097/aln.0000000000001432http://dx.doi.org/10.1097/aln.0000000000001432.

Kim HJ，Cha SI，Kim CH，et al. Risk factors of postoperative acute lung injury following lobectomy for nonsmall cell lung cancer［J］. Medicine （Baltimore），2019，98（13）：e15078.doi：10.1097/md.000 0000000015078http://dx.doi.org/10.1097/md.0000000000015078.

von Meyenfeldt EM，de Betue CT I，van den Berg R，et al. Wide variation in perioperative care in anatomical lung resections in the Netherlands： a national survey［J］. Semin Thorac Cardiovasc Surg，2020，32（4）：1101-1110.doi：10.1053/j.semtcvs.2020.05.015http://dx.doi.org/10.1053/j.semtcvs.2020.05.015.

Shin CH，Long DR，McLean D，et al. Effects of intraoperative fluid management on postoperative outcomes： a hospital registry study［J］. Ann Surg，2018，267（6）：1084-1092.doi：10.1097/sla.0000000000 002220http://dx.doi.org/10.1097/sla.0000000000002220.

Wu Y，Yang R，Xu J，et al. Effects of intraoperative fluid management on postoperative outcomes after lobectomy［J］. Ann Thorac Surg，2019，107（6）：1663-1669.doi：10.1016/j.athoracsur.2018. 12.013http://dx.doi.org/10.1016/j.athoracsur.2018.12.013.

Ahn HJ，Kim JA，Lee AR，et al. The risk of acute kidney injury from fluid restriction and hydroxyethyl starch in thoracic surgery［J］. Anesth Analg，2016，122（1）：186-193.doi：10.1213/ane.00000000 00000974http://dx.doi.org/10.1213/ane.0000000000000974.

Licker M，Hagerman A，Bedat B，et al. Restricted，optimized or liberal fluid strategy in thoracic surgery： a narrative review［J］. Saudi J Anaesth，2021，15（3）：324-334.doi：10.4103/sja.sja_1155_20http://dx.doi.org/10.4103/sja.sja_1155_20.

李晓阳，张志强，边庆虎，等. 目标导向液体治疗联合甲氧明对创伤性脑损伤患者围术期的影响［J］. 临床麻醉学杂志，2022，38（1）：23-28.doi：10.12089/jca.2022.01.005http://dx.doi.org/10.12089/jca.2022.01.005.

Li L，He LX，Yao YT. The efficacy and safety of pre-emptive methoxamine infusion in preventing hypotension by in elderly patients receiving spinal anesthesia： a PRISMA-compliant protocol for systematic review and meta-analysis［J］. Medicine （Baltimore），2022，101（49）：e32262.doi：10.1097/md.0000000000032262http://dx.doi.org/10.1097/md.0000000000032262.

胡敬利，李玲，焦宏梅，等. 甲氧明不同速率泵注对老年患者腹腔镜胃癌术后早期认知功能及血清炎性因子的影响［J］. 实用医院临床杂志，2023，20（1）：100-103.doi：10.3969/j.issn.1672-6170.2023.01.027http://dx.doi.org/10.3969/j.issn.1672-6170.2023.01.027.

Messina A，Caporale M，Calabrò L，et al. Reliability of pulse pressure and stroke volume variation in assessing fluid responsiveness in the operating room： a metanalysis and a metaregression［J］. Crit Care，2023，27（1）：431.doi：10.1186/s13054-023-04706-0http://dx.doi.org/10.1186/s13054-023-04706-0.

Thiele RH，Nemergut EC，3rdLynch C. The physiologic implications of isolated alpha（1） adrenergic stimulation［J］. Anesth Analg，2011，113（2）：284-296.doi：10.1213/ANE.0b013e318 2124c0ehttp://dx.doi.org/10.1213/ANE.0b013e3182124c0e.

Godai K，Hasegawa-Moriyama M，Matsunaga A，et al. Phenylephrine does not improve oxygenation during one-lung ventilation： a randomized，double-blind，cross-over study［J］. PloS One，2018，13（4）：e0195576.doi：10.1371/journal.pone.0195576http://dx.doi.org/10.1371/journal.pone.0195576.

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