摘要: |
目的 分析术中输注复方氨基酸对在全麻复合硬膜外阻滞下接受胃癌根治术患者苏醒质量的影响。方法 选择2016年1月至2019年6月在复旦大学附属中山医院行开放胃癌根治术的患者,随机分为氨基酸组和对照组,分别于手术开始后经颈内静脉输注11.4%复方氨基酸(18AA-Ⅱ)、0.9%氯化钠液2 mL·kg-1·h-1,持续2 h。评估两组拔管时间、麻醉苏醒质量(QoR-15评分及Richmond躁动-镇静评分)和不良反应;比较术前、术中及术后鼻咽温度、血糖,以及术后第1天外周血中性粒细胞计数、淋巴细胞计数、白细胞介素6(IL-6)和C反应蛋白(CRP)水平;记录并发症情况和住院时间。结果 共入选78例患者,氨基酸组35例、对照组43例。氨基酸组拔管时间早于对照组[7(5,10) min vs 12.5(10,15) min,P<0.001],QoR-15评分和躁动镇静水平优于对照组(P<0.001)。氨基酸组术中及术后鼻咽温度较对照组升高(P<0.001)。两组术后第1天IL-6和CRP水平均较术前升高(P<0.001);与对照组相比,氨基酸组术后第1天IL-6水平更高(P=0.048)。两组术后血糖水平、CRP、中性粒细胞及淋巴细胞水平差异无统计学意义。两组术后恶心呕吐、寒战、感染等并发症及住院时间差异无统计学意义。结论 胃癌根治术中输注复方氨基酸有助于加快苏醒,改善苏醒质量,改善围术期低体温,且对术后炎症水平、并发症及住院时间无明显影响。 |
关键词: 胃癌 麻醉 氨基酸 苏醒 |
DOI:10.12025/j.issn.1008-6358.2022.20210570 |
分类号:R614 |
基金项目:上海市临床重点专科建设项目(shslczdzk03603),上海申康医院发展中心临床三年行动计划资助项目(SHDC2020CR3048B),复旦大学附属中山医院临床研究专项课题(2018ZSLC27). |
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Effect of intra-operative amino acid infusion on recovery quality in patients undergoing open radical gastrectomy |
ZHAO Xi-ning, GE Sheng-jin, LIU Jie
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Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Abstract: |
Objective To investigate the effect of intra-operative infusion of amino acid on the postoperative recovery quality in patients undergoing gastrectomy. Methods The patients who underwent open radical gastrectomy from January 2016 to June 2019 were enrolled in the study and randomly assigned into two groups. The patients in the amino acid group received 11.4% 18-compound amino acid-Ⅱ via the jugular vein at the rate of 2 mL·kg-1·h-1 for 2 h during surgery. The patients in the control group received normal saline at the same rate and time. Primary outcomes were extubation and recovery, and the recovery quality was assessed by QoR-15 and Richmond agitation-sedation scale (RASS). Secondary indexes were nasopharyngeal temperature, blood glucose level, neutrophil count, lymphocyte count, interleukin-6 (IL-6), and C reactive protein (CRP) 1st day after surgery. Postoperative complications and length of hospital stay were also recorded. Results A total of 78 patients were enrolled, including 35 in the amino acid group and 43 in the control group. The extubation time was significantly earlier in the amino acid group than that in the control group (7[5, 10] min vs 12.5[10, 15] min, P<0.001). The QoR-15 and RASS scores were significantly better in the amino acid group than those in the control group (P<0.001). Nasopharyngeal temperatures during and after surgery were significantly lower in the control group than those in the amino acid group (P<0.001). The levels of IL-6 and CRP in both groups 1 day after surgery were significantly higher than before surgery (P<0.001); the IL-6 level of patient in the amino acid group was significantly higher than that in the control group 1 day after surgery (P=0.048). There was no significant difference in the levels of glucose, CRP, neutrophil count, lymphocyte count, postoperative nausea, and vomiting, shivering, infectious complications, etc., or length of hospital stay. Conclusions Intra-operative infusion of amino acid during gastrectomy could improve the recovery quality and reduce the risk of hypothermia without increasing inflammatory or glucose level. |
Key words: gastric cancer anesthesia amino acid recovery |