去甲肾上腺素在老年脊柱手术患者全身麻醉期间目标导向液体治疗中的应用：确定有效输注速率以增强术后功能
Norepinephrine in Goal-Directed Fluid Therapy During General Anesthesia in Elderly Patients Undergoing Spinal Operation: Determining Effective Infusion Rate to Enhance Postoperative Functions.
作者信息
Wu Fan, Liang Tao, Xiao Wei, Wang Tianlong
机构信息
Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, P.R. China.
出版信息
Curr Genomics. 2021 Dec 31;22(8):620-629. doi: 10.2174/1389202922666211213104944.
BACKGROUND AND OBJECTIVE
Intraoperative hypotension is a common complication in general anesthesia that could result in different serious complications particularly in elderly patients. This Randomized Clinical Trial (RCT) aims to determine effective continuous infusion rate of norepinephrine to prevent intraoperative hypotension during spinal surgery under general anesthesia in elderly patients.
METHODS
This RCT was conducted on elderly patients (n= 108) undergoing general anesthesia for posterior lumbar spinal fusion. The patients were randomly divided into 0.030, 0.060, and 0.090 μg.kg-1.min-1 groups of norepinephrine infusion rates. The outcomes were assessed at entrance to operation room (T0), 15 mins after anesthesia induction (T1), 60 mins following surgery (T2), and immediately after surgery (T3). The intraoperative and postoperative complications and rehabilitation outcomes were comparatively assessed.
RESULTS
All three groups significantly reduced the incidence of delayed wound healing (0.030 0.060 0.090 μg.kg.min; 33.3% 10% 10%, =0.024) and wound infection (26.7% 6.7% 6.7%, =0.031). Intraoperative total fluid volume and colloids volume in the 0.030 group were significantly higher than 0.060 and 0.090 groups (=0.005, =0.003, and =0.01, respectively). The 0.060 and 0.090 groups significantly increased mean-arterial-pressure than the 0.030 group at T2 and T3. Both 0.060 and 0.090 infusion rates significantly reduced intraoperative hypotension than 0.030 dosage (=0.01 and =0.003, respectively). The bradycardia incidence in the 0.090 group was significantly higher than the 0.030 (=0.026) and 0.060 groups (=0.038). The 0.060 group decreased the first intake by 1.4 hours (=0.008) and first flatus by 1.1 hours (=0.004) and postoperative hospital stay by 1 day (=0.066).
CONCLUSION
The 0.060 µg·kg·min norepinephrine infusion combined with goal-directed fluid therapy exhibited adequate intraoperative management and postoperative outcomes.
CLINICAL TRIAL REGISTRATION
www.chictr.org.cn, identifier ChiCTR-1900021309.
背景与目的
术中低血压是全身麻醉中常见的并发症，可能导致不同的严重并发症，尤其是在老年患者中。本随机临床试验（RCT）旨在确定去甲肾上腺素的有效持续输注速率，以预防老年患者在全身麻醉下脊柱手术期间的术中低血压。
方法
本RCT对108例接受后路腰椎融合术全身麻醉的老年患者进行。患者被随机分为去甲肾上腺素输注速率为0.030、0.060和0.090μg·kg⁻¹·min⁻¹的三组。在进入手术室时（T0）、麻醉诱导后15分钟（T1）、手术后60分钟（T2）和手术后即刻（T3）评估结果。对术中及术后并发症和康复结果进行比较评估。
结果
所有三组均显著降低了伤口延迟愈合的发生率（0.030、0.060、0.090μg·kg·min；33.3%、10%、10%，P = 0.024）和伤口感染率（26.7%、6.7%、6.7%，P = 0.031）。0.030组术中总液体量和胶体量显著高于0.060组和0.090组（分别为P = 0.005、P = 0.003和P = 0.01）。在T2和T3时，0.060组和0.090组的平均动脉压显著高于0.030组。0.060和0.090的输注速率均比0.030剂量显著降低术中低血压（分别为P = 0.01和P = 0.003）。0.090组的心动过缓发生率显著高于0.030组（P = 0.026）和0.060组（P = 0.038）。0.060组首次进食时间减少了I.4小时（P = 0.008），首次排气时间减少了1.1小时（P = 0.004），术后住院时间减少了1天（P = 0.066）。
结论
0.060μg·kg·min的去甲肾上腺素输注联合目标导向液体治疗显示出充分的术中管理和术后结果。
临床试验注册
www.chictr.org.cn，标识符ChiCTR - 1900021309。
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