硬膜外复合全身麻醉下急性高容量血液稀释对手术病人脑代谢的影响  

Effect of acute hypervolemic hemodilution on cerebral O_2 supply/consumption and energy metabolism during general anesthesia combined with epidural block in adults

作　　者：鲁卫华[1] 金孝岠[1] 徐晖[2] 朱美芳[1] 曹亚[1] 

机构地区：[1]皖南医学院附属弋矶山医院麻醉科,安徽省芜湖市241001 [2]安徽省蚌埠市第三人民医院麻醉科

出　　处：《中华麻醉学杂志》2006年第5期432-434,共3页Chinese Journal of Anesthesiology

基　　金：安徽省教育委员会自然科学研究项目(2003kj315)

摘　　要：目的探讨硬膜外复合全身麻醉下急性高容量血液稀释对手术病人脑代谢的影响。方法选择ASAⅠ或Ⅱ级择期手术病人14例,采用硬膜外阻滞复合全身麻醉,诱导后行右侧颈内静脉球部置管,呼气末异氟醚浓度稳定在1．2％时,经硬膜外导管注入1．33％利多卡因+0．167％地卡因10 ml后开始血液稀释,静脉输入6％羟乙基淀粉20 ml／kg,速率50 ml／min,分别于稀释前即刻(T0)、稀释后15min(T1)、120min(T2)采取桡动脉和颈内静脉球血,分别进行血气分析、乳酸、血糖、红细胞比容及血红蛋白(Hb)测定,计算动脉-颈内静脉球血血氧含量差[D(a-jv)O2]、脑氧摄取率(CERO2)、脑葡萄糖摄取率(CMRGlu)、动脉-颈内静脉球血乳酸浓度差。结果与T0比较,T1时颈内静脉球部血氧饱和度(SjvO2)上升,D(a-jv)O2、CERO2下降,T2时D(a-jv)O2下降,T1,2Hb降低(P<0．05),其余各指标差异无统计学意义。结论硬膜外复合全身麻醉下急性高容量血液稀释可增加脑氧供应,维持脑氧和能量代谢的稳定。Objective To investigate the effects of acute hypervolemic hemodilution （AHH） on cerebral O2 supply/consmnption and energy metabolism in patients undergoing elective surgery under general anesthesia combined with continuous epidural block. Methods Fourteen ASA Ⅰ or Ⅱ patients of beth sexes （9 male, 5 female） aged 44-62 yrs weighing 55-70 kg undergoing elective surgery under general anesthesia combined with epidural block were enrolled in this study. Lactated Ringer＇s solution 6-8 ml·kg^-1 was infused before anesthesia. After correct placement of epidural catheter was confirmed radial artery was cannulated for BP monitoring and blood sampling. BP, ECG, SpO2 and PETCO2 were continuously monitored during anesthesia. General anesthesia was induced with fentanyl, midazolam, propofol and rocuronium and maintained with isoflurane and intermittent i.v. boluses of vecuronium. The patients were intubated and mechanically ventilated. PETCO2 was maintained at 30-35 mm Hg. Epidural block was produced by a mixture of 1.33% lidocaine ＋ 0.167% dicaine. Right internal jugular vein was retrogradely cannulated and advanced cephalad until jugular bulb for blood sampling. AHH was conducted by infusing 6% HES 20 ml·kg^-1 at 50 ml·min^- 1 after induction of general anesthesia. Blood samples were taken from artery （a） and jugular venous bulb （iv） simultaneously before AHH （To ） at 15 min （T1 ） and 120 min （T2 ） after AHH was accomplished for blood gas analysis and determination of Hb, glucose and lactate concentrations. Cerebral O2 extraction rate （CERO2）, glucose extraction rate （CMRglu）, arterial-jugular bulb venous 02 content difference （ Da-jvO2 ） and arterial-jugular bulb venous lactate difference （VADL） were calculated. Results At the end of AHH Hct and Hb decreased by 20% as compared to the baseline values before AHH. S jvO2 was significantly higher, Da-jvO2 smaller and CERO2 lower at T1 than at T0. There were no significant differences in BP, HR, CMRglu and VADL at all time

关 键 词：血液稀释 氧耗量 葡萄糖 脑 麻醉 硬膜外 麻醉 全身 

分 类 号：R614.2[医药卫生—麻醉学]