异氟醚吸入麻醉对不同年龄组消化道恶性肿瘤患者血液流变学影响的临床研究  

The clinical study of isoflurane anesthesia on hemorheology in gastrointestinal cancer patients with different age

作　　者：张英[1] 廖长莉[1] 任长河[1] 俞虹[1] 于风旭[2] 唐显玲[1] 

机构地区：[1]泸州医学院附属医院麻醉科,646000 [2]泸州医学院附属医院心胸外科

出　　处：《国际麻醉学与复苏杂志》2012年第7期439-442,449,共5页International Journal of Anesthesiology and Resuscitation

基　　金：四川省卫生厅基金资助（20097464）;四川省科技厅基金资助（2011YJ0065）

摘　　要：目的观察异氟醚吸人麻醉对不同年龄组消化道恶性肿瘤患者血液流变学的影响，并对观察结果进行比较、分析，为临床吸入麻醉药物的选择提供依据。方法自2009年2月-2010年11月于泸州医学院附属医院选择ASAⅠ～Ⅱ级、行择期胃癌、直肠癌、结肠癌根治手术的患者50例，其中男29例，女21例，年龄37岁-73岁，根据年龄不同分为老年组（≥65岁）23例和中青年组（〈65岁）27例。诱导麻醉成功气管插管后，持续以异氟醚（3％-5％）、瑞芬太尼0．05μg·kg^-1·min^-1-0．2μm·kg^-1·min^-1、维库溴铵1μm·kg^-1·min^-1维持麻醉。所有患者分别在麻醉输液实施前（T0）、最低肺泡有效浓度（MAC）达到1～1.3时并维持1h（T1）、停吸入麻醉时（T2）、入麻醉后监测治疗室（postanesthesia care unit，PACU）后30min（T3）4个时间点各采血5ml，全自动血液流变快测仪测定高切变率全血黏度（H-qb）、中切变率全血黏度（Mηb）、低切变率全血黏度（Lηb）、血浆粘度（ηp）应用FASCO-3010血流变分析软件计算全血还原黏度（ηr）、红细胞聚集指数（erythrocyte aggregation index，EAI）、红细胞变形指数（erythrocyte deformation index，EDI）、红细胞刚性指数（erythrocyte rigidity index，ERI）等血液流变学指标。结果老年组患者与中青年组患者之间，T0点两组各个血液黏度指标皆无统计学差异。而Hηb、Mηb、Lηb以及ηr在T2皆存在统计学差异（F=7．05，7．27，7．71，5．07，P〈0．05）；Mηb、Lηb在T3仍存在统计学差异（F=7．22，7．79，P〈0．01）。EAI在T2有统计学差异（F=5．82，P〈0．05），在T3时存在统计学差异（F=8．79，P〈0．01）。EDI在随后各个时间点皆无统计学差异。ERI在T3时存在统计学差异（F=4．26，P〈0．05）。血沉方程K值在各个时间点两组之间皆无统计学差异。结论异氟醚麻醉对老年消化道恶性肿瘤患�Objective Observing the effect of isoflurane anesthesia on hemorheology of gastrointestinal cancer patients with different age, and analyzing the results to provide the basis for clinical inhalation anesthetics selection. Methods From February 2009 to November 2010, 50 patients （ASA Ⅰ -Ⅱ, 29 males, 21 females, aged 37 to 73 years old） of gastric cancer, rectal cancer or colon cancer in the Affiliated Hospital of Luzhou Medical College were divided into the old age group （≥65 y, n=23） and the young group（〈65 y, n=27）. After induction of anesthesia and endotracheal intubation, isoflurane （0.5 L/min -1 L/min）, remifentanil 0.05 μg· kg^-1· min^-1-0.2μg· kg^-1· min^-1 and vecuronium 1 μg· kg^-1· min^-1 were used to maintain anesthesia. In four time points ： before the infusion of anesthesia, 1 MAC-1.3 MAC （minimum alveolar concentration） achieved and maintain for 1 h, stopping inhalation anesthesia and 30 min after entering the postanesthesia care unit（PACU）, the high shear whole blood viscosity （Hηb）, middle shear whole blood viscosity （Mηb）, low shear whole blood viscosity （Lηb） were measured by fast automatic blood rheology measuring instrument and the plasma viscosity （ηp）, the whole blood reduced viscosity （ηr）, erythrocyte aggregation index （EAI）, erythroeyte deformability index （EDI）, erythrocyte rigidity index （ERI） and other blood rheology were calculated by FASCO-3010 software.Results There was no statistical difference on the blood viscosity at To between the elderly group and the young group. But the Hηb, Mηlb, Lηlb and ηr were significantly different （F=7.05, 7.27, 7.71, 5.07, P〈0.05）at T2 between two groups; Mηb, Lηb were significantly differents（F=7.22,7.79, P〈0.01 ） at T3 between two groups. EAI had significant difference at T2（F=5.82, P〈0.05） and at T3 （F=8.79, P〈0.01） between two groups; ERI had significant differences （F=4.26, P〈0.05） at T3 between two groups; Sedimentation equation K

关 键 词：消化道恶性肿瘤 围术期 血液流变学 异氟醚 年龄 

分 类 号：R614[医药卫生—麻醉学]