CAJ | 학술논문

目的探讨6%羟乙基淀粉130/0.4对患者硬膜外复合全麻诱导期肺循环血流动力学的影响.方法 26例肝胆外科手术患者,ASA Ⅰ～Ⅱ级,年龄32岁～59岁,体重54 kg～73 kg,随机分为羟乙基淀粉(HS)组和复方醋酸林格液(RL)组,每组13例,硬膜外复合全麻诱导前分别输入上述液体7 ml/kg,于基础值(T0)、输液后10 min(T1)、诱导后5 min(T2)、插管后5 min(T3)、插管后10min(T4)和插管后20min(T5)记录患者肺动脉收缩压(PASP)、肺动脉舒张压(PADP)、肺动脉平均压(MPAP)、肺动脉楔压(PAWP)、肺血管阻力(PVR)、右室心搏作功(RVSW)、中心静脉压(CVP)、心率(HR)、平均动脉压(MAP)等血流动力学参数.结果两组患者中性别比、年龄、身高、体质量和体表而积均无统计学差异(P>0.05).与T0相比,HS组T1时,PASP、PADP、MPAP、PAWP和CVP增加(P<0.05),PVR值T1到T5时下降(P<0.05或0.01);HS组患者RVSW值T5时下降(P<0.05);两组患者RVSW值T1时均增加(P<0.05或0.01);两组患者HR从T2到T5时下降(P<0.05或0.01),T3到T5时MAP降低(P<0.05或0.01);与RL组相比,HS组PVR值T1到T5时降低(P<0.05或0.01),T2到T5时MAP明显高于RL组(P<0.05或0.01).结论 7 ml/kg 6%羟乙基淀粉130/0.4能明显降低硬膜外复合全麻诱导期PVR,但对肺循环无明显副作用.
목적 탐토6%간을기정분130/0.4대환자경막외복합전마유도기폐순배혈류동역학적영향.방법 26례간담외과수술환자,ASA Ⅰ～Ⅱ급,년령32세～59세,체중54 kg～73 kg,수궤분위간을기정분(HS)조화복방작산림격액(RL)조,매조13례,경막외복합전마유도전분별수입상술액체7 ml/kg,우기출치(T0)、수액후10 min(T1)、유도후5 min(T2)、삽관후5 min(T3)、삽관후10min(T4)화삽관후20min(T5)기록환자폐동맥수축압(PASP)、폐동맥서장압(PADP)、폐동맥평균압(MPAP)、폐동맥설압(PAWP)、폐혈관조력(PVR)、우실심박작공(RVSW)、중심정맥압(CVP)、심솔(HR)、평균동맥압(MAP)등혈류동역학삼수.결과 량조환자중성별비、년령、신고、체질량화체표이적균무통계학차이(P>0.05).여T0상비,HS조T1시,PASP、PADP、MPAP、PAWP화CVP증가(P<0.05),PVR치T1도T5시하강(P<0.05혹0.01);HS조환자RVSW치T5시하강(P<0.05);량조환자RVSW치T1시균증가(P<0.05혹0.01);량조환자HR종T2도T5시하강(P<0.05혹0.01),T3도T5시MAP강저(P<0.05혹0.01);여RL조상비,HS조PVR치T1도T5시강저(P<0.05혹0.01),T2도T5시MAP명현고우RL조(P<0.05혹0.01).결론 7 ml/kg 6%간을기정분130/0.4능명현강저경막외복합전마유도기PVR,단대폐순배무명현부작용.
Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups(n=13): hydroxyethyl starch 130/0.4 group(HS)and complex acetic acid Ringer's solution (RL). Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamic parameters such as pulmonary arterial systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure(MPAP), pulmonary artery wedge pressure(PAWP), pulmonary vascular resistance(PVR) and right ventricular stroke work(RVSW) were recorded at base value(T0), 10 min after infusion(T1), 5 min after induction(T2), 5 rain after intubation(T3), 10 rain after intubation(T4)and 20 min after intubation(T5). Results PASP、PADP、MPAP、PAWP and CVP were significantly higher in group HS at T, than the values at T0 (P<0.05); PVR in group HS was obviously lower from T1 to T5 than the value at To (P<0.05 or P<0.01); RVSW was significantly higher in two groups at T1 than base value (P<0.05), but that in group HS was lower than base value (P<0.05 or P<0.01); HR obviously decreased in two groups from T2 to T5 as compared with the value at T0 (P<0.05); MAP was lower from T3 to T5 than the value at To (P<0.05 or P<0.01). PVR was obviously lower in group HS from T1 to T5 than that in group RL (P<0.05 or P<0.01); MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL(P<0.05 or P<0.01). Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction pe-riod from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.