椎管内阻滞在干细胞输注肾移植术中的应用  

Application of intravertebral anesthesia in renal transplantation of mesenchymal stem cells infusion

作　　者：刘韧[1] 王银模[1] 陈国忠[1] 

机构地区：[1]南京军区福州总医院麻醉科,福州350025

出　　处：《海军医学杂志》2013年第6期382-385,共4页Journal of Navy Medicine

摘　　要：[目的探讨干细胞输注肾移植术的麻醉方式，评估该情况下椎管内阻滞应用的安全性。方法回顾性分析124例肾移植术病例，男性95例，女性29例，分为静脉全身麻醉组（GA组，n=78），采用咪唑安定、丙泊酚、顺式阿曲库铵、芬太尼诱导插管，维持用微泵输注丙泊酚和瑞芬太尼；硬膜外＋腰硬联合麻醉组（E＋s组，n=46），硬膜外穿刺点选择T。。腰硬联合穿刺点选择L2-3，硬膜外用药为0．5％罗哌卡因＋1％利多卡因，腰麻罗哌卡因10mg/2．5ml。所有患者在移植肾动脉开放前10min静脉输注骨髓间充质干细胞。2组患者均于术前、术后检测凝血四项，记录2组手术时间和手术室停留时间，移植肾循环开放时的血压，术中出血量。观察术中、术后不良反应发生情况。结果2组患者手术前后凝血四项结果无明显变化（P〉0．05）；手术时间及出血量差异无统计学意义（P〉0．05）；GA组手术室停留时间[（4．20±0．33）h]明显长于E＋S组[（3．00±0．51）h]，差异有统计学意义（P〈0．05）；肾动脉开放时的收缩压、舒张压较E＋S组高，差异有统计学意义（P〈0．05）；E＋S组无硬膜外血肿发生。结论椎管内阻滞应用于干细胞输注肾移植术安全可行，但要规范操作。Objective To investigate the mode of anesthesia for mcsenchymal stem cells infusion in renal transplantation and also to assess the safety of intravertebral anesthesia under such circumstances. Methods Retrospective analysis was made on 124 cases of renal transplantation, which were composed of 95 male cases and 29 female cases. The patients were divided into the general anesthe- sia group （ or the GA group, n =78） and the epidural anesthesia ＋ spinal-epidural anesthesia group （ or the E ＋ S group, n =46）. For the GA group, the patients were given midazolam, propofol, fentanyl and cisatracurium besylate for induction and tracheal intuba tion. Micro-infusion pump was used for maintenance of general anesthesia through continuous infusion of propofol and remifentanil. The patients in the E ＋ S group were given epidural anesthesia （EA） at T11 and T12. Intervertebral space combined with spinal-epidural anesthesia was performed at 1.2 and L3. 0.5% Ropivacaine ＋ 1% lidocaine were used for EA, and 10 rag/2.5 ml Ropivacaine for spi nal anesthesia. All the patients were infused bone mesenchymal stem cells （BMSC） through vein, 10 min before the opening of trans planted renal artery. Four blood coagulation criteria of the patients in the 2 groups were detected both before and after surgery. Surgery duration, duration of stay in the operating room, blood pressure, following restoration of renal circulation and blood loss during surgery, were all recorded in both groups. Observation of adverse reactions was also closely monitored during surgery and after surgery for the two groups. Results No significant changes in the results of the 4 blood coagulation criteria could be seen in the patients of both groups both before and after surgery（P 〉 0.05 ）. No statistical significance could be noted in the duration of surgery and blood loss（ P 〉 0. 05 ）. The duration of surgery for the patients of the GA groups was significantly longer than that of the E ＋ S group [ （ 3.00 ± 0.51 ） h ] （P 〈

关 键 词：椎管内麻醉 间充质干细胞 肾移植 骨髓 

分 类 号：R614[医药卫生—麻醉学]