6％羟乙基淀粉130／0．4对患者硬膜外复合全麻诱导期肺循环的影响  

The effect of 6% hydroxyethyl starch 130 / 0.4 to pulmonary circulation during induction period from epidural block com- bined with general anesthesia

作　　者：杨泽勇 孙玉明[2] 杨立群[2] 吕浩[2] 俞卫锋[2] 范益明 

机构地区：[1]上海市青浦中心医院麻醉科,201700 [2]第二军医大学东方肝胆外科医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2009年第3期210-213,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨6％羟乙基淀粉130／0．4对患者硬膜外复合全麻诱导期肺循环血流动力学的影响。方法26例肝胆外科手术患者，ASAⅠ-Ⅱ级，年龄32岁～59岁，体重54kg～73kg，随机分为羟乙基淀粉（HS）组和复方醋酸林格液（RL）组，每组13例，硬膜外复合全麻诱导前分别输入上述液体7ml/kg于基础值（T0）、输液后10min（T1）、诱导后5min（T2）、插管后5min（L）、插管后10min（T4）和插管后20min（T5）记录患者肺动脉收缩压（PASP）、肺动脉舒张压（PADP）、肺动脉平均压（MPAP）、肺动脉楔压（PAWP）、肺血管阻力（PVR）、右室心搏作功（RVSW）、中心静脉压（CVP）、心率（HR）、平均动脉压（MAP）等血流动力学参数。结果两组患者中性别比、年龄、身高、体质量和体表面积均无统计学差异（P〉0．05）。与R相比，HS组T1时，PASP、PADP、MPAP、PAWP和CVP增加（P〈0．05），PVR值T1到T5时下降（P〈0．05或0．01）；HS组患者RVSW值T5时下降（P〈0．05）；两组患者RVSW值T1时均增加（P〈0．05或0．01）；两组患者HR从T2到T5时下降（P〈0．05或0．01），T3到T5时MAP降低（P〈0．05或0．01）；与RL组相比，HS组PVR值T1到T5时降低（P〈0．05或0．01），T2到T5时MAP明显高于RL组（P〈0．05或0．01）。结论7ml／kg 6％羟乙基淀粉130／0．4能明显降低硬膜外复合全麻诱导期PVR，但对肺循环无明显副作用。Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups（n= 13）： hydroxyethyl starch 130/0.4 group（HS）and complex acetic acid Ringer＇s solution （RL）. Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamie parameters such as pulmonary arterial systolic pressure （PASP）, pulmonary arterial diastolic pressure （PADP）, mean pulmonary artery pressure （MPAP）, pulmonary artery wedge pressure （PAWP）, pulmonary vascular resistance （PVR） and right ventricular stroke work （RVSW） were recorded at base value（T0）, 10 min after infusion（T1 ）, 5 min after induction （T2）, 5 min after intubation（T3）, 10 min after intubation（T4）and 20 min after intubation（T5）. Results PASP, PADP, MPAP, PAWP and CVP were significantly higher in group HS at T1 than the values at To （P〈0.05）; PVR in group HS was obviously lower from T1 to T5 than the value at To （P〈0.05 or P〈0.01 ）; RVSW was significantly higher in two groups at T1 than base value （P〈0.05）, but that in group HS was lower than base value （P〈0.05 or P〈0.01 ） ; HR obviously decreased in two groups from T2 to T5 as compared with the value at To （P〈0.05）; MAP was lower from T3 to T5 than the value at To （P〈0.05 or P〈0.01 ）. PVR was obviously lower in group HS from T1 to T5 than that in group RL （P〈0.05 or P〈0.01 ）; MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL（P〈0.05 or P〈0.01 ）. Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction period from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.

关 键 词：羟乙基淀粉 硬膜外 全麻 诱导期 肺循环 

分 类 号：R614[医药卫生—麻醉学]