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发行周期:
月刊
主管单位:
上海市卫生健康委员会
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CN31-1366/R
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当前位置：首页 > 过刊浏览->2011年第4期

全麻复合硬膜外麻醉对血流动力学的影响及其机制
The effect of epidural block combined with general anesthesia on hemodynamics (--the change of Stroke Volume Variation).

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DOI:
作者:
杨秀娟
YANG Xiujuan
作者单位:
上海市第一人民医院麻醉科
Department of Anesthesiology, Shanghai First People s Hospital
关键词:
每搏量变异度；硬膜外；全麻；血流动力学
Stroke Volume Variation (SVV), epidural block, general anesthesia , Hemodynamics
摘要:
[摘要] 目的 观察全麻复合胸段硬膜外麻醉时，硬膜外给予利多卡因对每搏量变异度(SVV)和血流动力学的影响，探讨低血压的发生机制。方法 ASAⅠ-Ⅱ级择期行胃部手术的患者40例，随机分为全麻复合胸段硬膜外麻醉组（C组）和单纯全麻组（G组），每组20例。C组在全麻诱导前先行T9-T12硬膜外穿刺并置管。两组均在全麻诱导前给予10ml/kg乳酸林格氏液，实验开始后以10ml/kg/h匀速输入。气管插管后行左桡动脉穿刺置管及右颈内静脉穿刺置管，持续监测每搏量变异度（SVV）、心排出量（CO）、每搏量（SV）、平均动脉压（MAP）、中心静脉压（CVP）和外周血管阻力（SVR）。C组经硬膜外导管给予2%利多卡因4ml。观察5、10、15、20分钟各参数的变化。结果 C组硬膜外给药后，MAP、SVR较基础值明显降低（P＜0.05)，而G组相应时间点则无明显变化，组间比较有统计学差异（P＜0.05）。C组SVV值较基础值稍增大，但无统计学差异（P＞0.05），而与G组比较则明显增大（P＜0.05）。结论 全麻复合下胸段硬膜外阻滞后，血压下降主要是由于外周血管阻力的降低引起，其次才是血容量不足的影响。
[Abstract] Objective To investigate the effects of thoracic epidural anesthesia with lidocaine on Stroke Volume Variation and hemodymics in patients under general anesthesia (TEA + GA), and explore the mechanism of hypotension. Method Forty patients of American Society of Anesthesiologists (ASA) class I or II, undergoing scheduled stomach operation, were randomized to TEA + GA group (n = 20, group C) or general anesthesia group (n = 20, group G ). Epidural catheter was placed in T9-T12 before induction of general anesthesia in group C. Ringer Lactate solution of 10ml/kg was infused intravenously in all patients before induction of anesthesia. It was maintained in 10ml/kg/h thereafter. After induction of anaesthesia, a left radial arterial cannulation and a right internal jugular catheter were placed for continuous monitoring of Stroke Volume Variation(SVV)，Cardiac Output(CO), stroke volume(SV),Mean Arterial Pressure(MAP), Central Venous Pressure(CVP) and Systemic Vascular Resistance(SVR). 2% lidocaine 4ml was given through epidural catheter in C group. All parameters were observed at 5th, 10 th, 15 th,and 20 th minute after epidural injection in group C or the same points in group G. Result There was no significant changes in MAP and SVR in group G. The MAP and SVR declined significantly (P＜0.05) in group C after epidural lidocaine. They were also lower than those in group G(P＜0.05). SVV increased slightly from baseline in group C without statistically significant difference. However, they were higher than those in group G (P<0.05). Conclusion The decline of SVR is the main reason of hypotension in epidural block combined with general anesthesia . The hypovolume is the secondary factor.

 

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