持续硬膜外输注局麻药可改善高血压病人全麻手术的循环稳定性

Continueus Epidural Infusion of Local Anaesthitic Could Improve the Hemodynamic in Hypertensive Patients during General Anaesthesia for Lower Abdominal Surgery

目的:观察持续硬膜外输注局麻药对全身麻醉下高血压病人循环的影响。方法:择期行下腹部手术的高血压病人60例,随机分为三组,即全麻组(A组)、全麻复合硬膜外麻醉组(B组)和全麻复合持续硬膜外输注组(C组),每组20例。分别记录:诱导插管时最高血压和最低血压,切皮、缝皮、拔管时血压,采用平均动脉压(MAP);手术中收缩压(SBP)波动值(大于140 mmHg和小于100 mmHg的总时间);切皮、缝皮时的异氟醚呼出值(ExIsoflu);芬太尼总用量;术后降压药使用情况。结果:MAP在围手术期各阶段, B组和C组均明显低于A组;ExIsoflu值,B组和C组在手术各阶段均明显小于A组。A组、B组和C组芬太尼总用量分别为(0．34 ±0．06)mg、(0．23±0．05)mg和(0．24±0．05)mg;SBP>140 mmHg的时间,B组和C组明显少于A组;SBP<100 mmHg的时间,B 组明显大于A组和C组;术后降压药使用情况,A组、B组和C组分别为10例、2例和3例。结论:对于行下腹部手术的高血压病人,全麻复合持续硬膜外输注的麻醉方法要优于单纯全麻或全麻复合硬膜外麻醉。

Objective： To compare the hemodynamic effects of general anesthesia, general anesthesia combined with epidural analgesia or continueus epidural infusion of local anaesthetic in hypertensive patients for lower abdominal surgery. Methods： Sixty patients, underwent lower abdominal surgery, were randomly assigned to receive either①general anesthesia（group A, n = 20）, ②combined general anesthesia and apidural anesthesia using 0.25% hupivacaine 10-12ml initially plus 3-4ml bolusly every an hour （group B,n=20）, or ③combined general anesthesia and apidural eonstanvrate infusion using 0. 250/00 bupivacaine at rate of （10-12）ml. h^-1 after a dose of （10-12）ml（group C,n= 20）. Changes of blood pressure（MAP） ,dosage of narcotic and accumulated duration of SBP〉140mmHg or of SBP〈100mmHg in perioperative period were recorded. Results： During the operation MAP in group B and group C is lower than that in group A （P〈0. 01）. ExIso in group B and group C is also lower than that in group A （P〈0. 01 ）. The duration of SBP〉140mrnHg in group A is more than that in group B and group C （P〈0. 01）. The duration of SBP〈100mrnHg in group B is more than that in group A andgroup C （P〈0. 01）. Conclusion：Continueus epidural infusion of local anaesthetic could improve the hemodynamic stability of hypertensive patients during general anaesthesia for lower abdominal surgery.