The kinetics of Ringer's solution in young and elderly patients during induction of general anesthesia with propofol and epidural anesthesia with ropivacaine
The kinetics of Ringer's solution in young and elderly patients during induction of general anesthesia with propofol and epidural anesthesia with ropivacaine
复制标题
DOI：
10.1111/j.1399-6576.2007.01351.x
复制
发表时间：
2007-08-01
影响因子：
2.1
通讯作者：
Hahn, R. G.
中科院分区：
文献类型：
--
作者：
Li, Y.;Zhu, S.;Hahn, R. G.
背景资料：不同的液体方案，往往采用老年患者，但它是不知道他们是否处理不同的输液诱导麻醉过程中比年轻patients.Methods：平均动脉压（MAP），血浆稀释（基于血红蛋白）和容量动力学进行了评估，在静脉（i. v.）29例患者（15例< 65岁，14例> 65岁）接受丙泊酚全身麻醉，16例患者（7例65岁）接受罗哌卡因腰段硬膜外麻醉，在60 min内输注1000 ml乳酸林格氏液< 65 years of age and 9 >。全麻引起的MAP下降幅度大于硬膜外麻醉（平均15%对9%; P < 0.001），随后是更明显的血浆稀释（30%对18%; P < 0.001）;最大值达到50%。液体诱导的血液稀释在麻醉开始后增加。分布速率常数（k（t）），它决定了输注液体保留血浆的偏好，显著降低，在全身麻醉期间达到最低值（P < 0.002）。然而，只有MAP的降低，而不是患者年龄组或麻醉类型本身，对诱导后的k（t）有统计学显着影响。结论：麻醉诱导大大增加了液体诱导的血液稀释，其幅度可以表示为输注液体的分布速率常数的急剧降低。该参数的诱导后值与MAP密切相关，但与患者年龄无关。
Background: Different fluid regimens are often adopted for elderly patients, but it is not known whether they handle infused fluids differently during the induction of anesthesia than young patients.Methods: Mean arterial pressure (MAP), plasma dilution (based on hemoglobin) and volume kinetics were assessed during an intravenous (i.v.) infusion of 1000 ml of lactated Ringer's solution over exactly 60 min in 29 patients given general anesthesia with propofol (15 < 65 years of age, and 14 > 65 years old) and in 16 patients receiving lumbar epidural anesthesia with titrated doses of ropivacaine (7 patients < 65 years of age and 9 > 65 years old).Results: General anesthesia caused a greater decrease in MAP than epidural anesthesia (mean 15% vs. 9%; P < 0.001) and was followed by a more pronounced plasma dilution (30% vs. 18%; P < 0.001); the maximum values reaching 50%. The fluid-induced hemodilution increased after the onset of anesthesia. The distribution rate constant (k(t)), which governs the preference for infused fluid to retain the plasma, was significantly reduced, with the lowest values being reached during general anesthesia (P < 0.002). However, only the reduction of MAP, and not the patient's age group or the type of anesthesia per se, had a statistically significant influence on k(t) after the induction.Conclusion: Induction of anesthesia greatly increases fluid-induced hemodilution, the magnitude of which can be expressed as an acute reduction of the distribution rate constant for infused fluid. The post-induction value of this parameter was closely associated with MAP but not with the patient's age.