全麻复合硬膜外阻滞对血液动力学的影响

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２１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     

年龄和禁饮食时间对下腹部手术患者硬膜外麻醉期间血液动力学的影响

硬膜外阻滞扩张外周血管造成外周血管阻力下降和回心血量减少,可以导致血液动力学紊乱,例如低血压、心排血量降低等。此外,长时间禁饮食会导致体内水分减少、血液浓缩,引起血容量不足。二者的协同作用会加重患者的血液动力学紊乱。本研究旨在探讨年龄及禁饮食时间对下腹部手术患者硬膜外麻醉期间血液动力学的影响。     

利多卡因硬膜外麻醉用于腹部手术对血液动力学的影响

本文观察５０例腹部手术应用２％利多卡因施行硬膜外阻滞对血液动力学影响。５０例病人分为上和中下腹部两组，每组２５例，结果表明：无论上腹部或中下腹部膜外阻滞后，其总的趋势是麻醉后平均动脉，每搏量，每搏指数，左室有效泵力，总外周血管阻力均降低，而主排血量，心脏指数，心率在上腹部组麻醉后下降，在中下腹部组则短时增加后又下降，提示２％利多卡因硬膜外阻滞对血流动力学都有一定程序的抑制作用，尤以腹部为基。     

腰麻-硬膜外联合麻醉对老年患者血液动力学的影响

目的 观察腰麻-硬膜外联合麻醉对老年患者血液动力学的影响.方法 选择60例65岁及以上ASA Ⅱ～Ⅲ级,择期行单侧下肢全膝关节置换术的患者,随机分成腰麻-硬膜外联合麻醉组和连续硬膜外麻醉组,每组30例.记录患者一般情况,手术时间,术中出血量,液体输入量.观察腰麻或硬膜外给药前、给药后15 min和术毕时的MAP及HR.记录感觉阻滞平面和改良Bromage运动分级.观察需要给与麻黄碱或阿托品的病例数,以及出现止血带疼痛的人数.结果 2组患者一般情况、手术时间、术中出血量、液体输入量无差异,感觉阻滞平面无明显差异,运动阻滞程度有显著差异.各个时间点的MAP及HR无显著性差异.2组给予麻黄碱和阿托品的例数无显著性差异.2组出现止血带疼痛的例数相比有显著行差异.结论 对行全膝关节置换术的老年患者实施腰麻-硬膜外联合麻醉,引起的血液动力学改变与硬膜外麻醉相比无明显差异,且患者止血带反应较轻.     

硬膜外阻滞复合全身麻醉对血液动力学和血管外肺水的影响

硬膜外阻滞复合全身麻醉在临床上已广泛运用。硬膜外阻滞后由于周围血管扩张而使外周阻力下降和回心血量减少 ,常可发生低血压。静脉麻醉药如异丙酚和硫喷妥钠等 ,对循环系统亦有抑制作用。因此在硬膜外阻滞后诱导插管 ,必将加重低血压[1,2 ] 。临床实际应用时为保持血压稳定 ,常在诱导前静脉输注晶体或 / (和 )胶体溶液扩充血容量以及静注小剂量血管活性药 (如麻黄碱 )。临床研究表明 ,扩充血容量确实能够降低麻醉诱导时低血压的发生率[2 ] 。但是否增加了血管外肺水容积量(ＥＶＬＷ)并引起术后肺部感染、低氧血症和心功能不全等并发症 ,至…     

氯胺酮对硬膜外阻滞病人血流动力学的影响

观测了氯胺酮对13例硬膜外麻醉病人血流动力学的影响.发现阻滞平面不超过T_4的病人对静注氯胺酮1 mg·kg~(-1)仍表现以心率增速为主的循环兴奋,提示当阻滞不够完善或内脏牵引反应强烈时可以应用小量氯胺酮,改善麻醉效果,减轻病人痛苦.但在使心交感神经完全或几乎完全阻滞的硬膜外麻醉病人,辅用氯胺酮应持慎重态度.     

硬膜外麻醉对肾移植受者血流动力学的影响

为了研究硬膜外麻醉对肾移植受者血流动力学的影响和意义，根据血压高低将肾移植患者分为３组，采用全自动无创血压监测仪测定患者麻醉前，手术平面固定事的基础动脉收缩压产进行比较。结果表明，ＳＢＰ〈２２．７ｋＰａ者，血压变化不明显；ＳＢＰ为２２．７－２５．３ｋＰａ者，５例中有３例血压下降，但下降幅度均〈４ｋＰａ，ＳＢＰ〉２５．３ｋＰａ者，所有病例均有明显的血压下降。     

食管超声多普勒监测硬膜外麻醉诱导期容量治疗的效应

目的比较不同种类预防性容量治疗对硬膜外麻醉诱导期血液动力学指标的影响,以探索合理的预防性容量治疗方法.方法选择在硬膜外麻醉下45例下肢或下腹部手术病人,随机分为三组,每组15例.A组：单纯输注复方乳酸钠;B组：按1：1比例输入复方乳酸钠和6%羟乙基淀粉;C组：单纯输注6%羟乙基淀粉.以食管超声多普勒技术持续监测：心脏指数（CI）、每博输出量指数（SI）、左室射血时间（LVET）、射血加速度（ACC）、峰速度（PV）、周身血管阻力指数（SVRI）.并观测MAP、HR、CVP.结果（1）当扩容结束时,C组CI、SI、PV较扩容开始显著提高（P＜0.05）,并高于A组和B组的水平,MAP无显著下降.（2）A组和B组血液动力学指标改善不显著,尤其是A组不能有效地防止硬膜外麻醉诱导期MAP的降低,CI和SI也无显著提高.结论硬膜外麻醉前应用6%羟乙基淀粉预防性扩容治疗可以有效地防止硬膜外麻醉诱导期的血液动力学紊乱.     

催产素对硬膜外阻滞患者血流动力学的影响

目的 探讨催产素对硬膜外阻滞患者血流动力学的影响.方法 择期子宫肌瘤剔除术患者26例,随机分为硬膜外阻滞组(E组)与全身麻醉组(G组),每组13例.E组采用2%利多卡因硬膜外阻滞.阻滞平面上界T_6～T_8;G组全身麻醉用丙泊酚、芬太尼、雷米芬太尼、维库溴铵和异氟醚.两组子宫肌瘤剔除后、血流动力学稳定时静注催产素5 U(注射时间:30 s).记录催产素注射前、注射后MAP、HR.结果 两组注射催产素后MAP均显著下降、HR显著增快(P<0.05或P相似文献   

Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals

Purpose We conducted a nationwide survey to investigate the current practice of the preoperative fasting period in Japanese anesthesia-teaching hospitals. Acceptance of the clinical practice guideline published by the American Society of Anesthesiologists (ASA) was also surveyed.Methods A written type-of questionnaire was mailed to 795 teaching hospitals.Results The response rate of the questionnaires was 57%. Most (>90%) of the respondents had been applying a longer fasting period than the ASA-recommended minimum period specifically in adults; the median duration of fasting was 12–13 h for solids and 6–9 h for liquids. Children or infants were allowed a more liberalized fasting period, frequently being permitted an oral intake of clear fluids up to 3 h before anesthesia. The incidence of pulmonary aspiration was 1/12 500 general anesthesia cases, and application of the ASA guideline appeared not to affect the incidence. Japanese anesthesiologists were still reluctant to depart from their traditional long fasting periods, as most of them could find little benefit in reducing the fasting periods.Conclusion The long preoperative fasting period is still common practice in Japanese anesthesia-teaching hospitals. A national guideline for a preoperative fasting policy is worth exploring to change the current practice.Some of the results of this study were reported at the 50th annual congress of the Japanese Society of Anesthesiologists, Yokohama, Japan     

不同剂量羟乙基淀粉电解质注射液预输注对胃切除术患者全麻诱导期血流动力学的影响

目的 探讨不同剂量6％羟乙基淀粉130/0.4电解质注射液预输注对胃切除术患者全麻诱导期血流动力学的影响.方法 择期行胃切除术患者90例,ASAⅠ或Ⅱ级,年龄40～50岁,根据全麻诱导前30 min输注6％羟乙基淀粉130/0.4电解质注射液的剂量随机分为低剂量组(L组,5ml/kg)、中剂量组(M组,10ml/kg)和高剂量组(H组,15ml/kg).以丙泊酚2mg/kg、罗库溴铵0.9mg/kg、舒芬太尼0.5 μg/kg麻醉诱导.以FloTrac/Vigileo方法测定并记录输注前(T1)、诱导前(T2)、气管插管前(T3)时的HR、MAP、心指数(CI)、每搏量(SV)、每搏变异度(SVV)、外周血管阻力(SVR)、CVP.结果 与T1时比较,T2、T3时三组患者MAP、CI、SV、CVP均明显升高,HR明显减慢,SVV、SVR明显降低(P＜0.05).与L组比较,T2、T3时M组和H组HR明显减慢,MAP、SV、CVP明显升高,SVV和SVR明显降低,且H组MAP和CVP明显高于M组,SVR明显低于M组(P＜0.05).结论 全醉诱导前输注6％羟乙基淀粉130/0.4电解质注射液10ml/kg可有效预防胃切除术患者全麻诱导期低血压的发生,维持相对稳定的血流动力学.     

Reducing preoperative fasting time: A trend based on evidence

Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma. Various randomized trials and meta-analyses have consistently shown that is safe to reduce the preoperative fasting time with a carbohydrate-rich drink up to 2 h before surgery. Benefits related to this shorter preoperative fasting include the reduction of postoperative gastrointestinal discomfort and insulin resistance. New formulas containing amino acids such as glutamine and other peptides are being studied and are promising candidates to be used to reduce preoperative fasting time.     

硬膜外麻醉时皮肤电传导变化的临床观察

目的探讨硬膜外麻醉时皮肤电传导(SC)基态值和反应波的变化。方法选择25例ASAⅠ或Ⅱ级下肢手术患者。记录硬膜外给药前(T0)、给予1%利多卡因5ml后5min(T1)、给予0.75%罗哌卡因10ml后5、10、15、25和45min(T2～T6)时的SC基态值(SC0)、针刺非阻滞区SC反应波的振幅差值(SC1)和痛觉阻滞区的SC反应波的振幅差值(SC2)。使用ROC曲线、逻辑回归分析评价SC反应波的振幅差值区分痛觉阻滞区和非阻滞区的准确性。结果与T0时比较,T3～T6时的SC0及SC1的均值明显降低(P<0.05),T1～T6时SC2明显低于SC1(P<0.05)。SC反应波的振幅差值ROC曲线下面积为0.928±0.017(P<0.01),特异性与敏感性分别为78%和88%,预测整体准确率84%。结论 SC基态值及反应波振幅差值的变化对定位硬膜外麻醉平面有一定指导作用。     

体位对择期剖宫产产妇循环和新生儿的影响

目的观察体位对产妇血流动力学及新生儿Apgar评分的影响。方法硬膜外麻醉下行择期剖宮产的产妇80例均分为四组,分别采用平卧位(S组)、左侧倾斜30°位(L组)、左侧倾斜15°同时头低15°位(LT组)、仰卧同时头低15°位(ST组)。记录各组麻醉前、麻醉后5、10、15 min、胎儿娩出即刻患者的MAP、HR、SpO2及新生儿1-、5-min的Apgar评分。结果麻醉后10 min,S、LT、ST三组MAP与麻醉前比较明显降低(P<0.05),也明显低于L组(P<0.05);新生儿出生后1-、5-min的Apgar评分组间差异无统计学意义。结论左侧倾斜30°位可有效降低剖宮产术中低血压的发生率。     

胸部手术实施全身麻醉联合硬膜外麻醉的效果观察

目的观察分析胸部手术实施全身麻醉联合硬膜外麻醉的效果。方法将42例SASⅠ~Ⅱ级胸部手术患者随机分为两组,各21例。对照组实施全身麻醉,观察组予以全身麻醉联合硬膜外麻醉,观察分析两组麻醉效果。结果 42例患者停止麻药后,自主呼吸恢复时间5~10 min。观察组患者麻醉药剂量明显少于对照组,且清醒时间早,两组比较,差异有统计学意义(P0.05)。结论采用全身麻醉联合硬膜外麻醉进行胸部手术,能降低麻药对循环及呼吸的抑制,缩短患者清醒时间,提高手术效果,值得临床推广应用。     

不同浓度布比卡因胸段硬膜外阻滞对单肺通气期间动脉氧合的影响

目的观察不同浓度布比卡因胸段硬膜外阻滞对单肺通气(OLV)期间动脉氧合的影响。方法择期行经左胸食管癌根治术患者120例,年龄50~65岁,随机数字表法均分为四组:A、B、C组采用静脉全麻复合硬膜外阻滞,硬膜外分别给予0.5%、0.25%、0.125%布比卡因,D组为单纯静脉全麻,每组30例。A、B、C三组患者诱导前硬膜外注入5ml相应浓度布比卡因,术中以3~5ml/h持续硬膜外泵入。分别于OLV前(T0)、OLV 15min(T1)、OLV 30min(T2)抽取桡动脉血和混合静脉血行血气分析。结果 T1、T2时A组Qs/Qt明显高于其他三组(P0.05),PaO2明显低于其他三组(P0.05)。T0~T2时A、B组SBP、DBP均明显低于D组(P0.05)。与D组比较,A、B、C组术中阿片类药物和丙泊酚的用量均明显减少(P0.05)。结论静脉全麻复合0.125%和0.25%布比卡因胸段硬膜外阻滞在OLV期间不会增加肺内分流和降低动脉氧合。     

Comparison of renal function under deliberate hypotension during epidural plus light-enflurane anesthesia and during enflurane anesthesia

We compared the effects of deliberate hypotension induced with trimethaphan on renal function and renal tubular damage under combined epidural and light-enflurane anesthesia (epidural group) and enflurane anesthesia alone (enflurane group). The mean arterial blood pressure was maintained at 50–55 mm Hg for 2.5 h in both groups using continuous infusion of trimethaphan. The urine volume and free water clearance were significantly greater in the epidural group than in the enflurane group [1.8±1.8 (SD)vs 0.4±0.3 ml·kg⁻¹·h⁻¹ and 0.81±1.30vs −0.15±0.22 ml·min⁻¹, respectively] (P<0.05). The creatinine clearance and fractional sodium excretion rate did not differ significantly between the two groups. Urinary excretion of norepinephrine was significantly less in the epidural group than in the enflurane group (P<0.05); however, epinephrine excretion did not differ. Urinary excretion ofN-acetyl-β-d-glucosaminidase was significantly less in the epidural group than in the enflurane, group (4.2±2.5vs 12.2±4.6 U·g⁻¹ CR) (P<0.01). The plasma antidiuretic hormone concentration was significantly lower in the epidural group compared to the enflurene group (13±23vs 57±42 pg·ml⁻¹) (P<0.05). No significant difference in plasma atrial natriuretic peptide concentration was found between the groups. We conclude that renal function during trimethaphan-induced hypotension is better maintained under epidural plus light-enflurane anesthesia than under enflurane anesthesia alone.