国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2012年
7期
439-442,449
,共5页
张英%廖长莉%任长河%俞虹%于风旭%唐显玲
張英%廖長莉%任長河%俞虹%于風旭%唐顯玲
장영%료장리%임장하%유홍%우풍욱%당현령
消化道恶性肿瘤%围术期%血液流变学%异氟醚%年龄
消化道噁性腫瘤%圍術期%血液流變學%異氟醚%年齡
소화도악성종류%위술기%혈액류변학%이불미%년령
Gastrointestinal caneer%Perioperative%Hemorheelogy%Isoflurane%Age
目的 观察异氟醚吸入麻醉对不同年龄组消化道恶性肿瘤患者血液流变学的影响,并对观察结果进行比较、分析,为临床吸入麻醉药物的选择提供依据.方法 自2009年2月～2010年11月于泸州医学院附属医院选择ASA Ⅰ～Ⅱ级、行择期胃癌、直肠癌、结肠癌根治手术的患者50例,其中男29例,女21例,年龄37岁～73岁,根据年龄不同分为老年组(≥65岁)23例和中青年组(＜65岁)27例.诱导麻醉成功气管插管后,持续以异氟醚(3％～5％)、瑞芬太尼0.05 μg·kg-1·min-1～0.2 μg· kg-1· min-1、维库溴铵1 μg· kg-1· min-1维持麻醉.所有患者分别在麻醉输液实施前(T0)、最低肺泡有效浓度(MAC)达到1～1.3时并维持1h(T1)、停吸入麻醉时(T2)、人麻醉后监测治疗室(postanesthesia care unit,PACU)后30min(T3)4个时间点各采血5ml,全自动血液流变快测仪测定高切变率全血黏度(Hηb)、中切变率全血黏度(Mηb)、低切变率全血黏度(Lηb)、血浆粘度(ηp)应用FASCO3010血流变分析软件计算全血还原黏度(ηr)、红细胞聚集指数(erythrocyte aggregation index,EAI)、红细胞变形指数(erythrocyte deformation index,EDI)、红细胞刚性指数(erythrocyte rigidity index,ERI)等血液流变学指标.结果 老年组患者与中青年组患者之间,T0点两组各个血液黏度指标皆无统计学差异.而Hηb、Mηb、Lηb以及ηr在T2皆存在统计学差异(F=7.05,7.27,7.71,5.07,P＜O.05)；Mηb、Lηb在L仍存在统计学差异(F=7.22,7.79,P＜0.01).EAI在T2有统计学差异(F=5.82,P＜0.05),在T3时存在统计学差异(F=8.79,P＜O.01).EDI在随后各个时间点皆无统计学差异.ERI在T3时存在统计学差异(F=4.26,P＜0.05).血沉方程K值在各个时间点两组之间皆无统计学差异. 结论 异氟醚麻醉对老年消化道恶性肿瘤患者血液流变学影响比较平缓,与老年组比较能明显降低中青年组消化道恶性肿瘤患者的血液黏度,异氟醚麻醉是一种安全的吸入麻醉药物.
目的 觀察異氟醚吸入痳醉對不同年齡組消化道噁性腫瘤患者血液流變學的影響,併對觀察結果進行比較、分析,為臨床吸入痳醉藥物的選擇提供依據.方法 自2009年2月～2010年11月于瀘州醫學院附屬醫院選擇ASA Ⅰ～Ⅱ級、行擇期胃癌、直腸癌、結腸癌根治手術的患者50例,其中男29例,女21例,年齡37歲～73歲,根據年齡不同分為老年組(≥65歲)23例和中青年組(＜65歲)27例.誘導痳醉成功氣管插管後,持續以異氟醚(3％～5％)、瑞芬太尼0.05 μg·kg-1·min-1～0.2 μg· kg-1· min-1、維庫溴銨1 μg· kg-1· min-1維持痳醉.所有患者分彆在痳醉輸液實施前(T0)、最低肺泡有效濃度(MAC)達到1～1.3時併維持1h(T1)、停吸入痳醉時(T2)、人痳醉後鑑測治療室(postanesthesia care unit,PACU)後30min(T3)4箇時間點各採血5ml,全自動血液流變快測儀測定高切變率全血黏度(Hηb)、中切變率全血黏度(Mηb)、低切變率全血黏度(Lηb)、血漿粘度(ηp)應用FASCO3010血流變分析軟件計算全血還原黏度(ηr)、紅細胞聚集指數(erythrocyte aggregation index,EAI)、紅細胞變形指數(erythrocyte deformation index,EDI)、紅細胞剛性指數(erythrocyte rigidity index,ERI)等血液流變學指標.結果 老年組患者與中青年組患者之間,T0點兩組各箇血液黏度指標皆無統計學差異.而Hηb、Mηb、Lηb以及ηr在T2皆存在統計學差異(F=7.05,7.27,7.71,5.07,P＜O.05)；Mηb、Lηb在L仍存在統計學差異(F=7.22,7.79,P＜0.01).EAI在T2有統計學差異(F=5.82,P＜0.05),在T3時存在統計學差異(F=8.79,P＜O.01).EDI在隨後各箇時間點皆無統計學差異.ERI在T3時存在統計學差異(F=4.26,P＜0.05).血沉方程K值在各箇時間點兩組之間皆無統計學差異. 結論 異氟醚痳醉對老年消化道噁性腫瘤患者血液流變學影響比較平緩,與老年組比較能明顯降低中青年組消化道噁性腫瘤患者的血液黏度,異氟醚痳醉是一種安全的吸入痳醉藥物.
목적 관찰이불미흡입마취대불동년령조소화도악성종류환자혈액류변학적영향,병대관찰결과진행비교、분석,위림상흡입마취약물적선택제공의거.방법 자2009년2월～2010년11월우로주의학원부속의원선택ASA Ⅰ～Ⅱ급、행택기위암、직장암、결장암근치수술적환자50례,기중남29례,녀21례,년령37세～73세,근거년령불동분위노년조(≥65세)23례화중청년조(＜65세)27례.유도마취성공기관삽관후,지속이이불미(3％～5％)、서분태니0.05 μg·kg-1·min-1～0.2 μg· kg-1· min-1、유고추안1 μg· kg-1· min-1유지마취.소유환자분별재마취수액실시전(T0)、최저폐포유효농도(MAC)체도1～1.3시병유지1h(T1)、정흡입마취시(T2)、인마취후감측치료실(postanesthesia care unit,PACU)후30min(T3)4개시간점각채혈5ml,전자동혈액류변쾌측의측정고절변솔전혈점도(Hηb)、중절변솔전혈점도(Mηb)、저절변솔전혈점도(Lηb)、혈장점도(ηp)응용FASCO3010혈류변분석연건계산전혈환원점도(ηr)、홍세포취집지수(erythrocyte aggregation index,EAI)、홍세포변형지수(erythrocyte deformation index,EDI)、홍세포강성지수(erythrocyte rigidity index,ERI)등혈액류변학지표.결과 노년조환자여중청년조환자지간,T0점량조각개혈액점도지표개무통계학차이.이Hηb、Mηb、Lηb이급ηr재T2개존재통계학차이(F=7.05,7.27,7.71,5.07,P＜O.05)；Mηb、Lηb재L잉존재통계학차이(F=7.22,7.79,P＜0.01).EAI재T2유통계학차이(F=5.82,P＜0.05),재T3시존재통계학차이(F=8.79,P＜O.01).EDI재수후각개시간점개무통계학차이.ERI재T3시존재통계학차이(F=4.26,P＜0.05).혈침방정K치재각개시간점량조지간개무통계학차이. 결론 이불미마취대노년소화도악성종류환자혈액류변학영향비교평완,여노년조비교능명현강저중청년조소화도악성종류환자적혈액점도,이불미마취시일충안전적흡입마취약물.
Objective Observing the effect of isoflurane anesthesia on hemorheology of gastrointestinal cancer patients with different age,and analyzing the results to provide the basis for clinical inhalation anesthetics selection.Methods From February 2009 to November 2010,50 patients (ASA I-Ⅱ,29 males,21 females,aged 37 to 73 years old) of gastric cancer,rectal cancer or colon cancer in the Affiliated Hospital of Luzhou Medical College were divided into the old age group ( ≥65 y,n=23) and the young group(＜65 y,n=27 ).After induction of anesthesia and endotracheal intubation,isoflurane (0.5 L/min -1 L/min),remifentanil 0.05 μg·kg-1·min-1-0.2 μg·kg-1·min-1and vecuronium 1 μg·kg-1·min-1 were used to maintain anesthesia.In four time points:before the infusion of anesthesia,1 MAC-1.3 MAC (minimum alveolar concentration) achieved and maintain for 1 h,stopping inhalation anesthesia and 30 min after entering the postanesthesia care unit(PACU),the high shear whole blood viscosity (Hηb),middle shear whole blood viscosity (Mηb),low shear whole blood viscosity (Lηb) were measured by fast automatic blood rheology measuring instrument and the plasma viscosity (ηp),the whole blood reduced viscosity (ηr),erythrocyte aggregation index (EAI),erythrocyte deformability index (EDI),erythrocyte rigidity index (ERI) and other blood rheology were calculated by FASCO-3010 software.Results There was no statistical difference on the blood viscosity at T0 between the elderly group and the young group.But the Hηb,Mηb,Lηb and ηr aere significantly different (F=7.05,7.27,7.71,5.07,P＜0.05)at T2 between two groups; Mηb,Lηb were significantly differents( F=7.22,7.79,P＜0.01 ) at T3 between two groups.EAI had significant difference at T2( F=5.82,P＜0.05 ) and at T3 (F=8.79,P＜0.01) between two groups; ERI had significant differences (F=4.26,P＜0.05) at T3 between two groups; Sedimentation equation K values at each time point showed no significant difference between the two groups.Conclusions The effect of isoflurane anesthesia in elderly parents with gastrointestinal cancer on Hemotheology was relatively gentle.Compared with the elderly group,the blood viscosity significantly reduced in young group.Isoflurane anesthesia is a safe inhaled anesthetics.
