心功能不全患者肾移植手术的麻醉管理  

The anesthesia of renal transplantation of patients with heart failure and end-stage renal failure

作　　者：陈菲[1] 张毅[2] 

机构地区：[1]云南省肿瘤医院麻醉科,昆明市650034 [2]昆明医学院第一附属医院麻醉科

出　　处：《河北医药》2006年第6期456-458,共3页Hebei Medical Journal

摘　　要：目的 探讨终末期肾功能衰竭（肾衰）并心功能不全患者行同种异体肾移植围术期部分血流动力学的变化和麻醉管理方法.方法术前评估40例终末期肾衰患者心功能并予相应处理,观察患者硬膜外麻醉后手术前（T1）、切皮（T2）、移植肾血管开放前（T3）、开放后1 h（T4）、缝皮（T5）5个时点的心率（HR）、血压（SBP、DBP）、中心静脉压（CVP）、脉搏血氧饱和度（SpO2）变化。结果 T2～T5和T1相比,SBP、DBP有显著降低，经液体扩容及小剂量多巴胺（2～8 μg·kg-1·min-1）持续泵入,SBP、DBP波动小于麻醉前的20%；T2～T4与T1相比,HR差异无显著性;CVP在T2～T5较T1升高，差异显著（P＜0.05）；T1～T5，SpO2＞90%，差异无显著性。结论 术前心功能检查,硬膜外麻醉,围术期的循环、水电解质酸碱平衡以及术后镇痛,以调节移植肾灌注和心脏负荷，是终末期肾衰并心功能不全患者行同种异体肾移植手术成功的关键。Objective To investigate the levels of HR, SBP, DBP, CVP and SpO2 in renal transplantation patients with heart failure and end-stage renal failure. Methods To evaluation the perioperafive risks of patients before operation. After epidual anesthesia, the changes of HR, SBP, DBP, CVP and SpO2 levels were observed at 5 time-points： the time before surgery （T1）, skin incising （T2）, before opening vascular anastnnosis （T3）, one hour after opening vascular anastrmosis （T4）, skin closing （T5）. Results The levels of SBP and DBP during T2 - T5 decreased more than those of T1, but there was no significant difference among T2-T5 ; the levels of HR did not change greatly between T2-T4 and Tl ; the change of CVP increased remarkably at the points of T2, T3, T4, T5 than that of T1 （ P 〈 0.05）; T1-T5, SpO2 〉 90%, there was no significant difference. Conclusion Sufficient preoperative investigation on circulatory system, epidual anesthesia, maintenance of perioperative circulation, water alectrolyte and acid-base balance and postoperative analgesia, regulating renal perfusion and heart load are the key for successful renal transplantation in patients with heart failure and end-stage renal failure.

关 键 词：终末期肾衰 心功能不全 硬膜外麻醉 肾移植 

分 类 号：R541[医药卫生—心血管疾病] R699.2[医药卫生—内科学]