陈安基,高建新,龙志忠,张治明,张峰华.碳酸氢钠预处理对膝关节置换手术中松止血带后的血流动力学的影响[J].转化医学杂志,2021,10(5):307-309+286
碳酸氢钠预处理对膝关节置换手术中松止血带后的血流动力学的影响
Effect of sodium bicarbonate pretreatment on hemodynamics after tourniquet release in TKA
  
DOI:
中文关键词:  止血带  TKA  碳酸氢钠  血流动力学
英文关键词:Tourniquet  TKA  Sodium bicarbonate  Hemodynamics
基金项目:湖南省自然科学基金支持项目(2019JJ40010)
作者单位
陈安基 湖南师范大学附属长沙市妇幼保健院麻醉重症科 
高建新 湖南师范大学附属长沙市妇幼保健院麻醉重症科 
龙志忠 郴州市第一人民医院麻醉科 
张治明 郴州市第一人民医院麻醉科 
张峰华 郴州市第一人民医院儿童呼吸科 
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中文摘要:
      目的 观察TKA中松开止血带前,以碳酸氢钠输注预处理对血流动力学的影响。方法 60例ASA II-III拟择期在全身麻醉下行膝关节置换的患者随机分为碳酸氢钠组(BR组,n=30)和复方林格组(RL组,n=30)。两组患者常规全麻下接受手术,手术中使用气压止血带止血,在松开止血带前分别泵注(15 min)5%碳酸氢钠250 mL(BR组)和复方林格液250 mL(RL组)。输注完成后松开止血带,观察心率(heart rate,HR),收缩压(systolic blood pressure,SBP),舒张压(diastolic blood, pressure,DBP),中心静脉压(central venous pressure,CVP)的变化,观察时间点:快速输注前(T1),快速输注5 min(T2),快速输注10 min(T3),松开止血带后5 min(T4),松开止血带后30 min(T5)。手术中使用间羟胺作为低血压调控药物。结果 (1)T1-T3 两组间血流动力学变化无统计学意义;(2)T4时,HR(P=0.046),SBP(P=0.006),DBP(P=0.02)改变情况均明显低于RL组(P<0.05);和T3比较,T4时,两组患者的SBP,DBP以及CVP均出现了明显程度的改变。T5时,改变的血流动力学情况有所恢复;(2)BR组的间羟胺使用量明显低于LR组(P=0.018)。结论 在TKA中在松开止血带前,静脉注射碳酸氢钠进行预处理,能有效缓解松开止血带所引起的血流动力学变化。
英文摘要:
      Objective To explore whether the hemodynamic changes caused by the release of tourniquet can be reduced by intravenous injection of sodium bicarbonate before releasing the tourniquet during the total knee replacement Arthroplasty (TKA). Methods Sixty patients who were ASA II-III candidates for elective TKA under general anesthesia were randomly grouped into two groups: bicarbonate group (BR group, n = 30) and ringer group (RL group, n = 30). During the operation, the tourniquet was loosened after the observation drugs were transfused, the changes of HR, SBP, DBP and CVP were noted. The observation time points were defined as before rapid infusion (T1), 5 min after rapid infusion (T2), 10 min after rapid infusion (T3), 5 min after loosening the tourniquet (T4), and 30 min after loosening the tourniquet (T5). Metaraminol was used as a hypotension rescue drug. Results (1) Hemodynamic changes were not statistically significant between the two groups at T1-T3; (2) Compared with T3, SBP, DBP and CVP of both groups changed significantly at T4. However, HR(P=0.046), SBP(P=0.006) and DBP(P=0.02) in group BR were significantly lower than those in group RL (P< 0.05). At T5, hemodynamic changes were restored and approached the level at T3 more quickly in the group BR. (2) The consumption of metaraminol in the BR group was significantly lower than that in the LR group (P=0.018). Conclusion In TKA, pretreatment with intravenous sodium bicarbonate before the release of tourniquet can effectively alleviate the hemodynamic changes caused by the release of tourniquet.
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