降压硬膜外麻醉和降压静脉全麻在全髋置换术中出血的比较  

Comparison of hypotensive epidural anesthesia and hypotensive total intravenous anesthesia on intraoperative blood loss during total hip replacement

作　　者：肖霖[1] 

机构地区：[1]江苏大学附属人民医院麻醉科,江苏镇江212002

出　　处：《现代医药卫生》2012年第3期323-324,326,共3页Journal of Modern Medicine & Health

摘　　要：目的比较降压硬膜外麻醉（hypotensive epidural anesthesia,HEA）和降压静脉全麻（hypotensive total intra-venous anesthesia,HTIVA）下全髋置换术的术中出血情况。方法对40例ASA分级Ⅰ、Ⅱ、Ⅲ级的行全髋置换术的患者作临床研究。患者接受HEA（HEA组,n=20）或HTIVA（HTIVA组,n=20）,并保持平均动脉压在50~60 mm Hg,记录这两组的低血压持续时间、出血、输血以及血流动力学等参数。结果接受HEA的患者比接受HTIVA的在术中出血、输红细胞压积（PRBCs）占百分比,总PRBCs输注要少（分别为P〈0.01,P〈0.05和P〈0.05）。HEA组术中平均中心静脉压比HTIVA组低（P〈0.05）。术后所有患者的神经检查都未受损。结论尽管术中平均动脉压相似,HEA组术中出血却要比HTIVA组少。这可能与HEA组非正压通气,血流重新分布以及术中较低的平均中心静脉压相关。Objective To compare the influence of hypotensive epidural anesthesia（HEA） and hypotensive total intravenous anesthesia（HTIVA） with propofol and remifentanil on blood loss during primary total hip replacement.Methods Forty patients with ASA physical status Ⅰ,Ⅱ and Ⅲ undergoing primary total hip replacement were performed the clinical study.The patients received either HEA（HEA group,n=20） or HTIVA（HTIVA group,n=20） to maintain mean arterial pressure 50-60 mm Hg.Duration of hypotension,blood loss,blood transfusion and hemodynamic parameters were recorded in both groups.Results Intraoperative blood loss,percentage of receiving blood substitution and total packed red blood cells transfused in the HEA group were less than those in the HTIVA group（P0.01,P0.05 and P0.05,respectively）.Mean intraoperative central venous pressure was lower in the HEA group than in the HTIVA group（P0.05）.The postoperative neurologic examinations of all cases showed unimpaired.Conclusion In spite the similar mean intraoperative arterial pressure levels noted between groups,HEA results in less intraoperative blood loss than HTIVA during primary total hip replacement,which could be related with non-positive pressure ventilation,redistribution of blood flow and lower mean intraoperative central venous pressure in the HEA group.

关 键 词：髋关节置换术 麻醉 降压硬膜外 降压静脉全身麻醉 出血 

分 类 号：R614.2[医药卫生—麻醉学]