腰麻前预扩容在阑尾切除术中的临床应用  

Clinical application of prae-dilatation before spinal anesthesia in appendectomy

作　　者：朱玉霖[1] 敖德富[1] 

机构地区：[1]四川省彭州市人民医院麻醉科,四川彭州611930

出　　处：《中国当代医药》2012年第36期86-87,共2页China Modern Medicine

摘　　要：目的探讨腰麻前预扩容在阑尾切除术中的临床应用。方法选择ASAⅠ～Ⅱ级行阑尾切除术患者54例,分为腰麻(Ⅰ)组、扩容+腰麻(Ⅱ)组和硬膜外麻醉(Ⅲ)组,每组18例,Ⅱ组患者入室立即静脉快速输注羟乙基淀粉6mL/kg体重后开始进行腰麻,Ⅰ组和Ⅱ组选择L2～3椎间隙向上注射0.5%布比卡因3mL,Ⅲ组选择T12～L1椎间隙向上置管后分次注射1.5%利多卡因直到满足手术要求。观察3组患者麻醉后5、10、15、20min和30min时的无创平均动脉压(MAP)、脉搏氧饱和度SpO2、心率(HR)的变化、麻醉起效时间。结果 3组患者均顺利完成手术,Ⅲ组起效时间明显长于Ⅰ、Ⅱ组(P<0.05);Ⅱ、Ⅲ组血压变化差异无统计学意义(P>0.05);Ⅰ组在麻醉后5、10min血压下降明显(P<0.05),麻醉后5min心率升高明显(P<0.05),10min时恢复到麻醉前水平(P>0.05);其余各指标变化两组间差异无统计学意义。结论在腰麻醉前预扩容可显著稳定患者麻醉过程中的血流动力学变化。Objective To investigate the clinical application of prae-dilatation before spinal anesthesia in appendectomy.Methods Fifty-four patients ASA statusⅠ-Ⅱ scheduled for appendectomy were equally divided into spinal anesthesia group（Ⅰ）,dilatation ＋ spinal anesthesia group（Ⅱ） and epidural anesthesia group（Ⅲ） for 18 cases.After entered operating room,patients in group Ⅱ accepted spinal anesthesia after rapid intravenous infusion of hydroxyethyl starch for 6 mL/kg,and patients in groupⅠandⅡ were injected with 0.5% bupivacaine 3 mL from L2-3 vertebral clearance.In group Ⅲ,1.5% lidocaine were fractionally injected into epidural space until the demands of the surgery were met from T12-L1 vertebral clearance.The noninvasive mean arterial pressure（MAP）,pulse oxygen saturation（SpO2）,heart rate（HR） change and the onset time of anesthesia in 3 groups at 5,10,15,20 min and 30 min after anesthesia were observed.Results The surgery of all patients in three groups were accomplished successfully,the onset time in group Ⅲ obviously longer than that in groupⅠand groupⅡ（P 〈0.05）.The change of blood pressure in group Ⅱand group Ⅲ had no statistical significance（P 〈0.05）.In groupⅠ,the blood pressure dropped obviously at 5 and 10 min after anesthesia（P 〈0.05）,the heart rate increased significantly at 5 min after anesthesia（P 〈0.05）,and then,it backed to the level before anesthesia at 10 min（P 〈0.05）.The changes of other indexes between two groups were not statistically significant.Conclusion Prae-dilatation before spinal anesthesia can significantly stable the hemodynamic changes of patients during anesthesia.

关 键 词：阑尾切除术 腰麻 预扩容 临床应用 

分 类 号：R614[医药卫生—麻醉学]