控制性低血压技术在坐位下肩关节镜手术的应用 |
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引用本文: | 娄晓平,王兰君,周蕾,汤新. 控制性低血压技术在坐位下肩关节镜手术的应用[J]. 中国医药, 2009, 4(12): 1010-1011. DOI: 10.3760/cma.j.issn.1673-4777.2009.12.036 |
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作者姓名: | 娄晓平 王兰君 周蕾 汤新 |
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作者单位: | 大连大学附属中山医院麻醉科,116011 |
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摘 要: | 目的探讨坐位(“沙滩椅”体位)下肩关节镜手术中行控制性低血压技术对患者的安全性。方法12例择期行肩关节镜手术患者,摆“沙滩椅”体位。术中以尼卡地平行控制性低血压,维持平均动脉压于60~65mmHg。分别在麻醉前,坐位前,坐位即刻,输入血定安后,降压30min、1h,结束后30min时记录心率、平均动脉压、中心静脉压(CVP)、pH值、PaO2、PaCO2、血液碱剩余(BE-B)值及尿量、清醒时间。结果在坐位时,CVP明显下降(P〈0.05),但经过补充血容量处理后,CVP可回复至平卧时水平。由于气管插管后吸入氧浓度增加,PaO2明显增高(P〈0.01)。控制性低血压期间平均动脉压明显低于麻醉前(P〈0.01)。结论坐位使得手术操作便利,患者生命体征平稳,控制性低血压技术在“沙滩椅”体位关节镜手术中对患者安全可靠。
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关 键 词: | 控制性低血压 全身麻醉 体位 肩关节镜手术 |
The application of controlled bypotension during shoulder arthroscopic surgery |
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Affiliation: | LOU Xiao-ping, WANG Lan-jun, ZHOU Lei, TNAG Xin. (Department of Anesthesiology, Zhongshan Hospital Affiliated to Dalian University, Dalian 116011, China) |
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Abstract: | Objective To evaluate the clinical safety of controlled hypotension during shoulder arthroscopic surgery in the sitting position. Methods Tweleve patients scheduled for shoulder arthroscopic surgery were anesthe-tized with remifentanyl-propofol-vecuronium after intravenous induction. All patients were administered with the in-dwelling radial artery cannula and right intrajugular venous catheter before sitting position. All patients were band-aged on chest with abdomen and two legs before the beach-chair position. HR, MAP, CVP, pHa, PaCO2, PaO2 time points were before anesthesia induction, before sitting position, immediately and after gelfasine infusion at sit-ting position, 30 min and 60 min after hypotension, 30 min after hypotension was over. Results CVP dropped im-mediately after sitting position (P<0.05) but restored to normal level after infusing gelfusine. During anaesthesia and operation there were no changes in artery PH, PaCO2 and BE-B, whereas PaO2 was kept at high level after in-duction of anesthesia and during operation (P<0.01). MAP decreased significantly during hypotension phase(P< 0.01). Conclusion The technique of controlled hypotension during shoulder arthroscopic surgery at the beach-chair position is safe and reliable. |
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Keywords: | Controlled hypoteasion General anaesthesia Position Shoulder arthroscopic surgery |
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