中国医药指南
中國醫藥指南
중국의약지남
CHINA MEDICINE GUIDE
2014年
27期
9-10
,共2页
全身麻醉%硬膜外麻醉%血液稀释%全髋置换术%血流动力学
全身痳醉%硬膜外痳醉%血液稀釋%全髖置換術%血流動力學
전신마취%경막외마취%혈액희석%전관치환술%혈류동역학
General anesthesia%Epidural anesthesia%Hemodilution%Total hip replacement%Hemodanynics
目的：观察急性高容量血液稀释（AHHD）对全麻复合硬膜外阻滞下行全髋置换手术患者血流动力学的影响。方法选择ASAⅠ~Ⅱ级，择期全髋置换术患者80例，随机分成全麻组（G组）和全麻符合硬膜外阻滞麻醉组（G/E组），每组40例，两组患者均在全麻诱导完成后实施AHHD，经中心静脉将羟乙基淀粉200/0.5氯化钠注射液500mL以40mL/min输注完毕，术中采用NICO无创心功能监护仪连续监测心排血量（CD）、心脏指数（CI）和外周血管阻力（SVR），同时监测平均动脉压（MAP）、中心静脉压（CVP）和心率（HR）。分别在AHHD前、AHHD完毕即刻、术毕和拔管时记录上述数据。结果麻醉后患者的MAP均降低，而在拔气管导管时MAP均升高；在AHHD前、AHHD完毕即刻、术毕和拔管时G/E组的MAP较G组低。两组患者的HR在拔管时均较快，而且在拔管时G组较G/E组快（P＜0.05）。两组患者的CI和CVP在AHHD完毕即刻、术毕和拔管时明显较AHHD前高（P＜0.05）。SVR在AHHD完毕即刻明显较AHHD前降低，术毕又基本恢复；G/E组患者的SVR较G组低（P＜0.05）。结论全麻复合硬膜外阻滞麻醉下行AHHD，应用于全髋置换术中可提高安全性。
目的：觀察急性高容量血液稀釋（AHHD）對全痳複閤硬膜外阻滯下行全髖置換手術患者血流動力學的影響。方法選擇ASAⅠ~Ⅱ級，擇期全髖置換術患者80例，隨機分成全痳組（G組）和全痳符閤硬膜外阻滯痳醉組（G/E組），每組40例，兩組患者均在全痳誘導完成後實施AHHD，經中心靜脈將羥乙基澱粉200/0.5氯化鈉註射液500mL以40mL/min輸註完畢，術中採用NICO無創心功能鑑護儀連續鑑測心排血量（CD）、心髒指數（CI）和外週血管阻力（SVR），同時鑑測平均動脈壓（MAP）、中心靜脈壓（CVP）和心率（HR）。分彆在AHHD前、AHHD完畢即刻、術畢和拔管時記錄上述數據。結果痳醉後患者的MAP均降低，而在拔氣管導管時MAP均升高；在AHHD前、AHHD完畢即刻、術畢和拔管時G/E組的MAP較G組低。兩組患者的HR在拔管時均較快，而且在拔管時G組較G/E組快（P＜0.05）。兩組患者的CI和CVP在AHHD完畢即刻、術畢和拔管時明顯較AHHD前高（P＜0.05）。SVR在AHHD完畢即刻明顯較AHHD前降低，術畢又基本恢複；G/E組患者的SVR較G組低（P＜0.05）。結論全痳複閤硬膜外阻滯痳醉下行AHHD，應用于全髖置換術中可提高安全性。
목적：관찰급성고용량혈액희석（AHHD）대전마복합경막외조체하행전관치환수술환자혈류동역학적영향。방법선택ASAⅠ~Ⅱ급，택기전관치환술환자80례，수궤분성전마조（G조）화전마부합경막외조체마취조（G/E조），매조40례，량조환자균재전마유도완성후실시AHHD，경중심정맥장간을기정분200/0.5록화납주사액500mL이40mL/min수주완필，술중채용NICO무창심공능감호의련속감측심배혈량（CD）、심장지수（CI）화외주혈관조력（SVR），동시감측평균동맥압（MAP）、중심정맥압（CVP）화심솔（HR）。분별재AHHD전、AHHD완필즉각、술필화발관시기록상술수거。결과마취후환자적MAP균강저，이재발기관도관시MAP균승고；재AHHD전、AHHD완필즉각、술필화발관시G/E조적MAP교G조저。량조환자적HR재발관시균교쾌，이차재발관시G조교G/E조쾌（P＜0.05）。량조환자적CI화CVP재AHHD완필즉각、술필화발관시명현교AHHD전고（P＜0.05）。SVR재AHHD완필즉각명현교AHHD전강저，술필우기본회복；G/E조환자적SVR교G조저（P＜0.05）。결론전마복합경막외조체마취하행AHHD，응용우전관치환술중가제고안전성。
Objective To investigate the effect of acute hypervolemic hemodilution(AHHD)on hemodynamics in patients who received total hip replacement with combined general and epidyral anesthesia. Methods 80 ASAⅠ-Ⅱ patients undergoing elective total hip replacement, were randomly divided into two groups, 40 each, general anesthesia group(group G)and combined general and epidural anesthesia group(group G/E). After induction of anesthesia, AHHD were performed by central vein administering 500 mL hydroxyethyl starch 200/0.5 sodium chloride injection by 40 mL/min. The following parameters were recorded before and after AHHD: mean arterial pressure(MAP), central venous pressure(CVP), heart rate (HR), as well as cardiac output(CD), cardiac index(CI)and peripheral vascular resistance(SVR)from NICO noninvasive heart function monitor. Results MAP of patients were decreased after induction of anesthesia and increased during extubation. Compared with group G, the MAP is lower just before, after AHHD, finishing of surgery and extubation(P<0.05). HR were increased in both groups, whereas groups G is faster than group G/E in extubation(P<0.05). CI and CVP were increased just after AHHD, finishing of surgery and extubation(P< 0.05). SVR after AHHD is lower than before and it was recovered after surgery, SVP in group G/E is lower than group G. Conclusion AHHD is able to improve outcome during total hip replacement with combined general and epidural anesthesia.
