全麻和硬膜外阻滞下升桥侧卧位手术时血流动力学改变比较观察

The Effect of Operation in Lateral Position of Risen Bridge on the Hemodynamic Changes During Intravenous Anesthesia and Epidural Blockade

为了比较全麻和硬膜外阻滞两种麻醉方法在升桥侧卧位手术时对人体循环功能的影响，以选择合理的麻醉方法，提高麻醉和手术的安全性。采用无创性连续心排血量监测仪（ＢＯＭＥＤ－ＮＣＣＯＭ—３），选择３０例肾结石手术患者，分为全麻组和硬膜外阻滞组，分别在麻醉和手术前、后仰卧和升桥侧卧位下对血流动力学变化进行了监测。结果发现：①全麻下升桥侧卧位手术对人体循环影响轻微。②硬膜外阻滞下平面达Ｔ５～１２时，仰卧位时循环系统各项参数无明显变化，改升桥侧卧位后发现心排血量（ＣＯ）、心脏指数（ＣＩ）、每搏量（ＳＶ）、每搏指数（ＳＩ）、体循环血管阻力（ＳＶＲ）等６项循环参数均有明显变化。对其适应证及注意事项进行了讨论。

cases of renal lithiasis were divided into intravenous and epidural anesthesia groups to observe by continous noninvasive cardiac output monitor (BOMED NCCOM 3). Before and after anesthesia and operation, we monitored the hemodynamic changes between supine and lateral, position of risen bridge in order to choose an appropriate anesthesic method and to enhance the safety of anesthesia. The results are as follows: ① The effect on hemodynamic was lighter during opration in lateral position of risen bridge by intravenous anesthesia. ② With the anesthesia level at T 5￣12 during epidural blockade, all the parameters about circulation in supine had no obvious change, but while changing into lateral position of risen bridge, five circulation parameters such as CO, CI, SV, SI, SVR all changed remarkably. It showed that the circulation volume decreased significantly.