| Objectives: Perioperative care programs in elective colorectal surgery based on Enhanced Recovery After Surgery?ERAS?have been shown to be safe and effective,Fluid management have been reported as a key factor influencing the outcome of ERAS in anesthesia management is associated with early recovery of postoperative gastrointestinal function and complications.Clinical studies have shown that fluid-restricted management is consistent with ERAS and can improve the prognosis of patients with colorectal surgery.However,the restrictive transfusion may lead to subclinical hypotension,which may affect the tissue perfusion,but small doses of norepinephrine in restrictive transfusion has been verified on the improvement of the tissue perfusion.Phenylephrine and norepinephrine are commonly used in clinical practice to counteract hypotension,the effect of phenylephrine on tissue oxygen metabolism in elderly patients undergoing restrictive transfusion is still lack of clinical research.In this study,we observed the effects of phenylephrine on tissue oxygen metabolism in elderly patients undergoing fluid-restricted,and provided a reference for fluid management of elderly patients with colorectal surgery.Method: After hospital ethics Committee approval,and written informed consent was obtained from all patients,60 elderly patients,aged:65-80 yr,with a body mass index of18-24 kg·m-2,undergoing elective colorectal surgery,were randomly divided into two groups:phenylephrine group?group A?and norepinephrine group?group B?.Lactated Ringer,S solution was given at a rate of 5 ml·kg-1·h-1 and small dose of Phenylephrine was infused intravenously at 0.1-0.3?g·kg-1·min-1 simultaneously during the surgery?group A?,or norepinephrine 0.01-0.03?g·kg-1·min-1?group B?,and MAP was maintained ?65 mm Hg.Intraoperative blood loss was replaced with the equal volume of6% hydroxyethyl starch 130/0.4.Before the surgery?baseline?,1 h and 2 h after beginning of the surgery,and while leaving postanesthesia care unit,MAP,HR,CVP were recorded,and arterial and central venous blood samples were drawn for blood gas analysis.Blood samples were taken form the peripheral vein to determine the concentration of Hb,blood urea nitrogen?BUN?and creatinine?Cr?before the surgery and1 day after the surgery.pulmonary complications,gastrointestinal complications,and wound infections were recorded.Results: The general data of the two groups : age,BMI,sex ratio and ASA classification had no significant difference.The amount of blood loss,urine volume,fluid volume,operation time and each time point of MAP,HR,CVP,Lac,Pa O2,Pcv O2,Scv O2,ERO2,renal function index,pulmonary complications and gastrointestinal complication rate was no significant difference between the two groups during operation.Compared with group B,Hb,Ca O2,Ccv O2 and Da-cv O2 in group A were significantly decreased?P<0.05?.Conclusion: In the elderly patients undergoing fluid-restricted abdominal surgery,phenylephrine and norepinephrine can well maintain tissue perfusion and oxygen supply,has little effect on the organizational function,but compared with phenylephrine,norepinephrine has little influence on the oxygen content of the elderly patients... |
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