急性高容量血液稀释对硬膜外麻醉下老年患者循环功能及心肌钙蛋白的影响  

Effect of acute hypervolemic hemodilution on circulation function and cardiac troponin I in the elderly patients under epidural anesthesia

作　　者：吕机生[1] 张美玲[1] 邵大清 叶志坚[1] 

机构地区：[1]浙江省金华市人民医院麻醉科,浙江金华321000

出　　处：《中国急救医学》2004年第6期403-404,共2页Chinese Journal of Critical Care Medicine

基　　金：金华市科学技术局立项项目 (No .金市科字 [2 0 0 3 ] 2 0号 )

摘　　要：目的　观察急性高容量血液稀释 (AHH)对硬膜外麻醉下老年患者循环功能及心肌钙蛋白I(CTnI)的影响 ,探讨AHH在老年患者术中应用的安全性。方法　选择ASAⅠ～Ⅱ级、无心肺疾患的硬膜外麻醉老年患者 30例 ,随机分为血液稀释组 (H组 )和对照组 (C组 )。硬膜外麻醉成功后 ,H组按 5 0mL/min的速率输注 6 %羟乙基淀粉 ( 6 %HES ,2 0 0 / 0 .5 ) 15mL/kg,C组输乳酸林格氏液 15mL·kg-1·h-1。麻醉前、切皮前、术毕、术后 4h监测并记录SBP、DBP、HR、CVP、Hct、血气及CTnI。结果　硬膜外麻醉后两组血压均下降 ,C组下降较H组明显 ,H组实施AHH后CVP明显升高 ,但基本在正常范围之内。两组术中各时点血气分析变化差异无显著性。CTnI在组内各时点及组间相应时点差异无显著性 (P >0 .0 5 ) ,且CTnI始终处在低值(≤ 0 .1ng/mL)。结论　一般情况良好、无心肺疾患的老年患者硬膜外麻醉下实施AHH ,对循环功能影响较小 ,心肌损伤不明显。Objective To investigate the effect of acute hypervolemic hemodilution (AHH) on circulation function and cardiac troponin I (CTnI) in the elderly patients under epidural anesthesia,and to evaluate the safety of AHH with 6% hydroxyethyl starch(HES) in the elderly patients under epidural anesthesia. Methods Thirty ASAⅠ～Ⅱ elderly patients under epidural anesthesia without cardiac and pulmonary disease were randomly divided into two groups: hemodilution group (H, n=15) and control group (C,n=15). The patients were premedicated with intramuscular sodium phenobarbital 0.1 g and atropine 0.3 mg. Epidural anesthesia was done at T 11 ～L 4. Group H, AHH was performed with 6% hydroxyethl starch (200/0.5) 15 mL/kg infused at a rate of 50 mL/min before skin incision. Group C, infused with Ringer's lactate solution at a rate of 15 mL·kg -1 ·h -1 . Radial artery was cannulated for direct Bp monitoring and internal jugular vein was cannulated for CVP monitoring and infusing. Before anesthesia, before skin incision,the end of operation,4 h after surgery, SBP,DBP,HR,CVP,cardiac troponin I, blood gas analysis and HCT were monitored and recorded. Results After epidural anesthesia (after AHH in group H) blood pressure were all decreased in both groups , and it decreased significantly in group C . CVP were significantly higher after AHH in group H, but normotensive mostly. CTnI showed little change during and after operation in both groups. Conclusion Under epidural anesthesia AHH was used for treating the elderly patients without cardiac and pulmonary disease, which have little influence on circulation function and myocardial injury.

关 键 词：血液稀释 老年人 心肌钙蛋白 循环功能 硬膜外麻醉 

分 类 号：R61442[医药卫生—麻醉学]