胸部硬膜外阻滞复合异氟醚降压对动脉导管未闭结扎术后高血压反应的影响

Effects of thoracic epidural block combined with inhalation of isoflurane on postoperative rebound hypertension after ligation of patent dutus ar teriosus (PDA)

目的 探讨术中胸部硬膜外阻滞 (TEA)复合异氟醚降压对动脉导管未闭 (PDA)结扎术后高血压反应的影响。方法 40例PDA结扎术的病人随机分为两组 :TEA组术中采用TEA +异氟醚降压( 2 0例 ) ,S组采用硝普钠 (SNP) +异氟醚降压 ( 2 0例 ) ,分别于术前、插管后、降压开始、降压结束、手术结束采血测定血浆肾上腺素 (E)、去甲肾上腺素 (NE)、血管紧张素Ⅱ (AngⅡ )、醛固酮 (ALD)浓度 ,于手术结束、术后 12、2 4、48h记录VAS <3时MAP、HR变化及血管扩张药使用情况。结果 TEA组血E、NE、AngⅡ、ALD浓度较术前无明显变化 ,而S组各时点E、NE、AngⅡ、ALD浓度明显高于TEA组 (P <0 .0 1)。TEA组术后 19例 ( 95 %)MAP、HR无明显变化 ,仅 1例使用血管扩张药 ,而S组术后 7例 ( 3 5 %)出现高血压 ;TEA组高血压发生率低于S组 ( P <0 .0 5 ) ,术后 48h应用SNP和巯甲丙脯酸 (CAP)剂量显著低于S组。

Objective To investigate the effects of thoracic epidural anesthesia (TEA) combined with inhalation of isoflurane on postoperative rebound hypertension after ligation of patent dutus arteriosus (PDA).Methods Forty PDA patients were randomly divided into two groups:in group TEA (n=20),isoflurane inhalation+thoracic epidural block was performed to control the patient’s blood pressure;in group S (n=20),isoflurane inhalation+sodium nitroprusside was used by intravenous infusion.Blood samples were taken before anesthesia,3 minutes after intubation,beginning of hypotension,during hypotension and at end of operation for determination of concentration of epinephrine (E),norepinephrine (NE),angiotensin Ⅱ (AngⅡ) and aldosterone (ALD).VAS scores in all patients were controlled within 3 by PCEA after operation.MAP,HR and the dosage of vasodilator drugs at the end of operation,12 h,24 h and 48h after operation were recorded.Results the levels of plasma concentration of E,NE,AngⅡ and ALD increased significantly in group S,but there was no significantly difference before and after operation in group TEA.7 patients (35%) in group S vs 1 patient (5%) in group TEA needed vasodilator drugs to control hypertension after operation (P<0.05).There was no significant changes for MAP and HR before and after operation in group TEA.The incidence of hypertension in group S was significantly higher than that in group TEA.The dosage of vasodilator drugs was significantly higher in group S than that in group TEA.Conclusion Thoracic epidural block combined with inhalation of isoflurane can prevent the rebound hypertension induced by increased plasma concentration of vasoconstrictor hormones in patients undergoing ligation of patent dutus arteriosus.