食管超声多普勒监测硬膜外麻醉诱导期容量治疗的效应  

Effects of volume therapy on hemodynamic variables monitored by transesophageal echo-Doppler during epidural anesthesia induction

作　　者：潘志英[1] 王祥瑞[1] 孙瑗[1] 陈杰[1] 杨跃武[1] 郑拥军[1] 

机构地区：[1]上海第二医科大学仁济医院麻醉科,200127

出　　处：《临床麻醉学杂志》2005年第10期659-661,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较不同种类预防性容量治疗对硬膜外麻醉诱导期血液动力学指标的影响,以探索合理的预防性容量治疗方法。方法选择在硬膜外麻醉下45例下肢或下腹部手术病人,随机分为三组,每组15例。A组:单纯输注复方乳酸钠;B组:按1∶1比例输入复方乳酸钠和6%羟乙基淀粉;C组:单纯输注6%羟乙基淀粉。以食管超声多普勒技术持续监测:心脏指数(CI)、每博输出量指数(SI)、左室射血时间(LVET)、射血加速度(ACC)、峰速度(PV)、周身血管阻力指数(SVRI)。并观测MAP、HR、CVP。结果(1)当扩容结束时,C组CI、SI、PV较扩容开始显著提高(P<0.05),并高于A组和B组的水平,MAP无显著下降。(2)A组和B组血液动力学指标改善不显著,尤其是A组不能有效地防止硬膜外麻醉诱导期MAP的降低,CI和SI也无显著提高。结论硬膜外麻醉前应用6%羟乙基淀粉预防性扩容治疗可以有效地防止硬膜外麻醉诱导期的血液动力学紊乱。Objective To assess the effects of fluid administration on hemodynamic variables measured by transesophageal echo-Doppler during epidural anesthesia induction. Mothods Forty-five patients undergoing selective lower limb or lower abdomen operation under epidural anesthesia were randomly divided into three groups with 15 patients each. Ringer＇s solution was infused in group A, Ringer＇s solution combined with 6 % HES in group B, 6 % HES alone in group C. The volume infused in each group was 10 ml/kg. Stroke index （SI）, cardiac output index （CI）, heart rate （HR）, blood flow acceleration（ACC）, peak velocity （PV）,left ventricular ejection time（LVET）, and systemic vascular resistance index（SVRI） were continuously monitored with HemoSonic^TM 100 transesophageal Doppler technic during volume therapy. Results After volume therapy with 6% HES in group C, CI, SI and PV increased more than those in group A and B（P〈0.05） ,MAP did not decrease significantly. Volume therapy with Ringer＇s solution could not effectively prevent the disorders of hemodynamics induced by epidural anesthesia. Conclusion 6% HES can effectively prevent the disorders of hemodynamics during enidural anesthesia induction.

关 键 词：血液动力学 羟乙基淀粉 硬膜外麻醉 硬膜外麻醉 麻醉诱导期 容量治疗 超声多普勒监测 食管 血液动力学指标 羟乙基淀粉 超声多普勒技术 血液动力学紊乱 

分 类 号：R445.1[医药卫生—影像医学与核医学] R614[医药卫生—诊断学]