两种麻醉方法对高血压病人血液流变性影响的比较  

The Influence of Two Anesthetic Techniques on Hemorheological Parameters in Hypertensive Patients

作　　者：王春艳[1] 童庭辉[2] 唐显玲[1] 

机构地区：[1]泸州医学院附属医院麻醉科,四川泸州646000 [2]泸州医学院附属医院整形烧伤科,四川泸州646000

出　　处：《中国微循环》2009年第4期308-311,共4页Journal of Chinese Microcirculation

基　　金：四川省教委重点科研基金资助(0236/440)

摘　　要：目的观察全身麻醉和硬膜外麻醉对高血压病患者血液流变性影响的异同。方法选择ASAⅠ～Ⅱ级、行择期腹部手术并伴有高血压病的患者共30例。按麻醉方式随机分为硬膜外组(EA)和气管插管全身麻醉组(GA)各15例。麻醉实施及围术期处理按常规进行,统一输液标准。所有病人分别在麻醉前及麻醉后30min、术毕(平均在麻醉后90min)、术后24h于肘静脉各采血4.5ml,毛细管法检测高切全血黏度(200s-1)、低切全血黏度(3s-1)、全血还原黏度(ηr)、血浆黏度(ηp)、红细胞聚集指数(EAI)、变形指数(EDI)、刚性指数(ERI)等。结果与麻醉前比较,麻醉期间两组全血高切、低切黏度、ηr、ηp、EAI均明显降低(P<0.05),GA组麻醉30min内指标降低已很明显,术毕时有所升高;EA组于麻醉30min以后各指标才明显降低,但术毕时仍在低水平维持。两组术后24h各指标即逐渐升高。GA组EDI在麻醉期间曾一度降低,术后24h下降明显(P<0.05)。结论全身麻醉更快地使高血压病患者术中血液黏度指标降低,但硬膜外麻醉改善血液流变性的效果较持久,且未发现围麻醉期红细胞变形能力降低。Objective To investigate the hemorheologic changes of hypertensive patients during perioperation and compare the influence of epidural anesthesia and general anesthesia on blood viscosities. Methods We studied 30 patients with systolic blood pressure （SBP） ≥ 140 mmHg and/or diastolic blood pressure （DBP） ≥90mmHg, ASA classification Ⅰ - Ⅱ, who received elective abdomen operation and had no other factors influencing hemorheology. They randomly received epidural anesthesia or general anesthesia, then were divided into two groups（ EA and GA） 15 cases each. Two groups adopted unified transfusion method. Blood sample from all patients were taken at pre.anesthesia, 30rain and 90rain after anesthesia, 24h after operation. The blood samples were taken 4.5ml each time from elbow vein and were tested for the hemorheologieal measurements within four hours in vitro. Blood viscosity was determined at a shear rate of 200s^-1 and 3s^-1 at 37℃ using an automatic theological-examining machine, hematocrit（Hct） using capillary. Patients＇ SBP/DBP and HR were monitored during experiments. Results Blood viscosity（ ηb and ηp） decreased（ P 〈 0.05） in two groups during anesthesia and increased in postoperative period. The change happened within 30 minutes during anesthesia in GA group but after 30 minutes in EA group. Whereas the melioration of blood viscosity was longer in EA group. Conclusion The two anesthetic technologies can meliorate hemorheology in hypertensive patients. It happened earlier in GA group but longer in EA group without bad effect on RBC deformability index.

关 键 词：全身麻醉 硬膜外麻醉 高血压病 血液流变性 

分 类 号：R614[医药卫生—麻醉学] R544.1[医药卫生—外科学]