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| 预防性输注去甲肾上腺素对老年腹腔镜肠道手术患者术后胃肠功能的影响 |
| Effect of preemptive infusion of norepinephrine on postoperative gastrointestinal function in elderly patients undergoing laparoscopic intestinal surgery |
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| DOI：10.12089/jca.2026.03.004 |
| 中文关键词: 去甲肾上腺素 老年 腹腔镜肠道手术 胃肠功能 |
| 英文关键词: Norepinephrine Aged Laparoscopic intestinal surgery Gastrointestinal function |
| 基金项目:国家自然科学基金面上项目（82171207）；江苏省自然科学基金面上项目（BK20231246）；江苏省科协青年科技人才支持项目（2021-008）；江苏省“333”高层次人才培养工程优秀青年人才（2022-3-6-146） |
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| 中文摘要: |
目的： 探讨预防性输注去甲肾上腺素对老年患者腹腔镜肠道手术后胃肠功能的影响。
方法： 选择择期全麻下行腹腔镜肠道手术的老年患者，年龄65～85岁，BMI 18.5～30.0 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：预防性输注去甲肾上腺素组（P组）和对照组（C组）。患者行气管插管全身麻醉，术中采用静-吸复合麻醉，基于脉搏压变异度（PPV）和MAP等动态血流动力学参数，执行目标导向液体管理（GDFT）策略。P组自麻醉诱导开始持续泵注去甲肾上腺素0.01 ～ 0.1 μg·kg-1·min-1，C组泵注等量生理盐水，仅在循环不稳定时根据情况单次或持续泵注去甲肾上腺素。主要指标为术后首次肛门排气时间，次要指标包括手术时间、麻醉时间、术中输液量、出血量、尿量，术中舒芬太尼、瑞芬太尼和去甲肾上腺素用量，术中多巴酚丁胺、麻黄碱和艾司洛尔使用率，经口进食时间和首次排便时间，术后24、48、72、96 h进食-恶心-呕吐-查体-症状持续时间评分系统（I-FEED）评分，术后胃肠道功能障碍（POGD）和术后24 h内恶心呕吐发生率。
结果： 共纳入患者100例，每组50例。与C组比较，P组术中输液量明显减少，术中多巴酚丁胺和麻黄碱使用率明显降低，术中艾司洛尔使用率明显升高，术后首次肛门排气时间、首次经口进食时间、首次排便时间和术后住院时间均明显缩短，术后24、48、72、96 h I-FEED评分、POGD 发生率、术后恶心呕吐发生率明显降低（P<0.05）。
结论： 预防性输注去甲肾上腺素能够有效缩短老年肠道手术患者术后胃肠功能恢复时间，降低术后POGD发生率，减少术中液体输注量，缩短术后住院时间，是一种行之有效的围术期管理策略。 |
| 英文摘要: |
Objective: To investigate the effect of preemptive infusion of norepinephrine on gastrointestinal function in elderly patients after laparoscopic intestinal surgery.
Methods: Elderly patients aged 65-85 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic intestinal surgery under general anesthesia were enrolled. Patients were randomly divided into two groups using a random number table: the norepinephrine group (group P) and the control group (group C). All patients underwent tracheal intubation general anesthesia combined with intravenous-inhalational anesthesia, and goal-directed fluid therapy (GDFT) was performed based on dynamic hemodynamic parameters including pulse pressure variation (PPV) and MAP. Group P received continuous infusion of norepinephrine 0.01-0.1 μg·kg-1·min-1, starting from anesthesia induction, while group C received an equal volume of normal saline, with norepinephrine administered as single or continuous bolus only when circulatory instability occurred. The primary outcome was time to first postoperative anal exhaust. Secondary outcomes included operation time, anesthesia time, intraoperative fluid input, blood loss, urine output, the intraoperative usage of sufentanil, remifentanil and norepinephrine, the intraoperative usage rate of dobutamine, ephedrine, and esmolol, the time to first oral intake, the time to first defecation, the intake, feeling nauseated, emesis, physical exam, and duration (I-FEED) scores at 24, 48, 72, and 96 hours postoperatively,the incidence of postoperative gastrointestinal dysfunction (POGD) and postoperative nausea and vomiting (PONV) within 24 hours.
Results: A total of 100 elderly patients were enrolled, 50 patients in each group. Compared with group C, the intraoperative fluid infusion volume was significantly reduced, the intraoperative utilization rates of dobutamine and ephedrine were significantly reduced, while the usage rate of esmolol significantly increased, the time to first postoperative anal exhaust, the time to first oral intake, the time to first defecation, and postoperative hospital stay were significantly shortened, the I-FEED scores at 24, 48, 72, and 96 hours postoperatively, and incidence of POGD and PONV were significantly decreased in group P (P < 0.05).
Conclusion: Preemptive norepinephrine infusion can effectively shorten the recovery time of postoperative gastrointestinal function, reduce the incidence of POGD, reduce intraoperative fluid infusion, and shorten postoperative hospital stay in elderly patients undergoing laparoscopic intestinal surgery, representing an effective perioperative management strategy. |
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