扩容对蛛网膜下隙阻滞病人低血压的预防效力  

The preventive efficacy of fluid expansion on hypotension during spinal anesthesia

作　　者：嵇富海[1] 马绮[1] 薛张刚[1] 蒋豪[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海市200032

出　　处：《临床麻醉学杂志》2003年第12期725-727,共3页Journal of Clinical Anesthesiology

摘　　要：目的　应用容量扩张动力学分析不同液体、不同时机输注对蛛网膜下隙阻滞病人低血压的预防机制。方法　 6 0例择期行下腹部手术的病人 ,随机分为四组 :Ⅰ组 ,麻醉前输注复方乳酸钠(LR) ;Ⅱ组 ,麻醉前输注 6 %羟乙基淀粉 (HES) ;Ⅲ组 ,麻醉即刻输注复方乳酸钠 ;Ⅳ组 ,麻醉即刻输注 6 %HES。输液前及输液后 6 0min内每 5分钟测定Hb、Hct、RBCV ,并观察血液动力学的变化。计算血容量 (BV)、液体潴留量 (FR)及容量扩张效率 (VEE)。结果　低血压、麻黄碱用量和恶心、呕吐的发生率Ⅰ组明显高于其他组。麻醉后的 10min ,Ⅰ组留在血管内的液体 (FR % )明显比Ⅱ组、Ⅲ组、Ⅳ组的少。Ⅰ组、Ⅲ组最大扩张量在输液结束前 5min ,并且Ⅲ组的扩张量明显比Ⅰ组大。Ⅱ组、Ⅳ组的扩张量明显比Ⅰ组、Ⅲ组的大 ,并且下降较为缓慢 ,它们最大扩张量在输液结束后 5min。Ⅱ组、Ⅳ组的扩张效率明显比Ⅰ组、Ⅲ组的大。结论　应用动力学分析表明只有在蛛网膜下隙阻滞即刻输注复方乳酸钠能减少低血压的发生率 ,而 6 %HES不管是麻醉前还是麻醉即刻输注都减少低血压的发生率。Objective To compare the effect of different fluid and time on prevention of hypotension during spinal anesthesia.Methods 60 patients undergoing elective abdominal operations were randomly divided into 4 groups with 15 cases each. 1 000 ml lactated Ringer′s solution(LR) was administered during 20 min before spinal anesthesia in group Ⅰ,and 500 ml 6% hydroxyethylstarch(HES)in group Ⅱ. 1 000 ml LR was administered during 20 min after spinal anesthesia in group Ⅲ,and 500 ml 6% HES in Group Ⅳ.The incidence of hypotension(systolic blood pressure<80% of baseline and <90 mmHg),and the amount of ephedrine used are compared.Before and after spinal anesthesia,blood sample was drawn for the measurements of blood haemoglobin(Hb)concentration and haematocit(Hct) every 5 min during 60 min after fluid infusion.Results The incidence of hypotension was higher in group Ⅰ than that in the other groups(67% vs 27%,40%,33%).So did the amount of ephedrine.During 10 min after spinal anesthesia,the fluid retained(FR) in blood was lower in group Ⅰ than that in the other groups.The blood volume as the biggest during 5 min before fluid infusion in group Ⅰ and Ⅲ.But the blood volume as the biggest during 5 min after fluid infusion in group Ⅱ and Ⅳ. Intravascular volume expansion efficiency(VEE)was higher in group Ⅱ and Ⅳ than that in group Ⅰ and Ⅲ.Conclusion The hypotension of spinal anesthesia can be attenuated by volume expansion with LR used only at the time of spinal blockade,or with 6% HES used before or at the time of spinal blockade.

关 键 词：蛛网膜下隙阻滞 低血压 扩容 预防 容量扩张动力学 麻醉 并发症 

分 类 号：R614[医药卫生—麻醉学]