不同禁饮食时间对硬膜外麻醉病人血液动力学的影响

Effect of different preoperative fasting time on hemodynamics during epidural anesthesia

目的观察不同禁饮食时间与硬膜外麻醉病人血液动力学变化的关系。方法30例择期下肢或下腹部手术成年病人,分为两组。A组,术前禁饮食8h;B组术前禁饮食12h。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)、血管阻力指数(SVRI)。同时监测平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)。结果(1)与基础值相比,A组的SI、CI、ACC下降不显著,B组在硬膜外注药10min后ACC、CI、PV开始出现显著降低。(2)与A组相比,B组在硬膜外注药10min后SI、CI、ACC、PV显著降低,CI、ACC、MAP的变化幅度显著大于A组。结论术前禁饮食12h的病人在硬膜外麻醉诱导期会引起显著的血液动力学紊乱。

Objective To assess the effect of different preoperative fasting duration on hemodynamics by transesophageal echo-doppler monitoring during epidural anesthesia.Methods Thirty patients undergoing selective lower limb or lower abdomen operation under epidural anesthesia were randomly divided into one of two groups with 15 cases each.Group A was preoperatively fasted for 8h, and group B for 12h.Mean arterial pressure(MAP), heart rate (HR),central venous pressure(CVP) were continuly monitored. Stroke index (SI),cardiac index (CI), blood flow acceleration(ACC), peak velocity (PV),left ventricular ejection time(LVET), total systemic vascular resistance index(SVRI) were continuly monitored with HemoSonic~(TM) 100 transesophageal Doppler technic. (Results )(1)In group A, SI,CI,ACC did not decreased significantly than the baselines,while in group B these values decreased significantly.(2) In group B, SI,CI,ACC,PV lowered more than those in group A 10min after epidural anesthesia. Conclusion Hemodynamics could be changed dramatically during epidural anesthesia induction in patients with preoperative fasting longer than 12h.