经皮肾镜碎石术麻醉期间血浆胶体渗透压和凝血功能的变化  

The change of plasma colloid osmotic pressure and blood coaglulation in percutaneous nephrolithotripsy during anesthesia

作　　者：吴立新[1] 梁敬柱[1] 张志刚[1] 凌泉[1] 张春元[1] 

机构地区：[1]中山大学附属中山医院麻醉科,广东省中山528403

出　　处：《中国基层医药》2010年第19期2603-2604,共2页Chinese Journal of Primary Medicine and Pharmacy

基　　金：广东省中山市科技计划项目（2008A107）

摘　　要：目的 探讨经皮肾镜碎石术麻醉期间血浆胶体渗透压和凝血功能的变化,为预防和治疗其并发症的发生提供依据.方法 择期拟行上尿路结石经皮肾镜碎石术的患者30例,随机分为全麻组和腰硬联合麻醉组各15例.全麻组用咪哒唑仑注射液0.1 mg/kg、异丙酚1.5 mg/kg、维库溴胺0.15 mg/kg、芬太尼4 μg/kg诱导,异氟醚1～1.3 MAC持续吸入维持麻醉.腰硬联合麻醉组行T11～12或T12～L1椎间隙硬膜外置管,然后行L2-4椎间隙穿刺腰麻,腰麻用药为布比卡因10 mg,硬外用0.75%罗哌卡因8～10 ml,麻醉平面控制在T6以下;分别记录手术开始前与结束时的血浆胶体渗透压、中心静脉压、TEG各项数值、手术时间和灌洗液用量.结果 两组患者组内术后与术前比较,血浆胶体渗透压明显降低,CVP明显升高（P〈0.01）,R值减小（P〈0.05）.腰硬联合麻醉组寒战、焦虑等不适发生10例.结论 经皮肾镜碎石术中,COP随着手术时间的延长和灌洗液的用量增多有不同程度的降低,CVP逐渐升高,有引起心力衰竭、肺水肿等并发症的风险,凝血功能影响不明显.Objective To provide basis of preventing and treating complications by monitoring plasma colloid osmotic pressure and blood clotting function during anesthesia of percutaneous nephrolithotomy （PCNL）.Methods 30 patients with upper urinary calculus were equally and randomly divided into two groups according to the different anesthesia method. In General anesthesia group, Midazolam 0. 1 mg/kg、diprivan 1.5mg/kg、Vecuronium bromide 0. 15mg/kg、fentanyl 4μg/kg were used to guide and forane 1 ～ 1.3MAC were used to keep inhalation anesthesia. In lumbar-epidural anesthesia group T12～12 or T12 ～ L1 epidural anesthesia with 0.75% ropivacaine 8 ～ 10 ml and L2～4 lumbar anesthesia with bupivacaine 10mg were used. Plasma colloid osnotic pressure, central venous pressure and TEG were detected at the beginning and at the end of operation and fluid consumption were compared between the two groups. Results There was no obvious difference between the two groups. In both groups ,COP was obviously reduced and CVP was improved after the operation which significantly different with those pre-operation （ all P 〈0. 01 ）. R value reduced significantly（P 〈0. 05）. There were 10 patients complicated with chilling, unconffortability,or anxiety. Conclusion During anesthesia of percutaneous nephrolithotomy, with operation time going on, COP reduced obviously, which increased the risk of heart failure, pulmonary edema, etc. but had no effect on blood clotting.

关 键 词：经皮肾镜碎石术 血浆胶体渗透压 血栓弹性描记图 

分 类 号：R614[医药卫生—麻醉学]