全麻复合硬膜外阻滞对血液动力学的影响  

Effects of combination of general and epidural anesthesia on hemodynamics

作　　者：王健[1] 王泉云[1] 田奇[1] 王儒蓉[1] 

机构地区：[1]华西医科大学附属第一医院麻醉科,成都610041

出　　处：《中华麻醉学杂志》2000年第8期474-476,共3页Chinese Journal of Anesthesiology

摘　　要：目的　观察浅全麻复合硬膜外阻滞对血液动力学的影响。方法　随机将 2 1例择期行腹腔镜胆囊切除手术病人分为全身麻醉组 (GA组 ,11例 )和浅全麻复合硬膜外阻滞组 (GA +EA组 ,10例 ) ,采用Swan Ganz导管技术 ,分别监测GA组吸入 0 .6MAC、1.0MAC安氟醚与GA +EA组吸入0 .6MAC安氟醚基础上硬膜外注入 2 %利多卡因 7ml前后血液动力学的变化。结果　两组吸入 0 .6MAC安氟醚 ,MAP均显著下降 (P <0 .0 5 ) ,HR、SVR、SI、CI均无显著性变化 (P >0 .0 5 )。GA组吸入1MAC安氟醚 ,与基础值相比 ,MAP、HR、SVR、SI及CI显著性下降 (P <0 .0 5 )。GA +EA组硬膜外注药使MAP、SVR明显下降 (P <0 .0 5 ) ,CI无明显变化 (P >0 .0 5 ) ,SI显著升高 (P <0 .0 5 )。结论　浅全麻复合硬膜外阻滞是一种较好的麻醉方式 ,但应重视血容量补充或使用血管活性药物 ,以减少血液动力学波动。Objective To observe the influences of combined general and epidural anesthesia on hemodynamics.Methods Twenty one patients were randomly divided into two groups, general anesthesia (GA group, n=11) and combined general and epidural anesthesia (GA+EA group, n=10). With Swan Ganz technique, hemodynamic parameters were measured 5min following 0.6 and 1.0 MAC enflurane inhalation in GA group, and 5min following 0.6 MAC enflurane inhalation and 10min after combined epidural lidocaine in GA+EA group.Results Compared with the baselines, in both groups with 0.6 MAC enflurane inhalation, MAP decreased significantly (P<0.05), HR, systemic vascular resistance (SVR), stroke index (SI), cardiac index (CI) changed unsignificantly(P>0.05); in GA group with 1.0 MAC enflurane inhalation, MAP, HR, SVR, SI and CI decreased significantly (P<0.05), in GA+EA group with combined epidural anesthesia, MAP and SVR markedly reduced(P<0.01), but CI and SI remained stable (P>0.05). As compared with those following 0.6 MAC enflurane inhalation, only in GA+EA group MAP and SVR decreased, and SI rose obviously (P<0.05) after combined epidural anesthesia.Conclusions Combination of mild general and epidural anesthesia is applied better, but the supplement of the blood volume or the administration with vascular active drugs should be noticed in order to reduce the fluctuation of hemodynamics.

关 键 词：全身麻醉 硬膜外麻醉 血液动力学 

分 类 号：R614[医药卫生—麻醉学]