腰硬联合麻醉行下肢骨科手术止血带对循环和代谢的影响

EFFECTS OF TOURNIQUET ON CIRCULATION AND METABOLISM DURING LOWER LIMB SURGERY UNDER COMBINED SPINAL-EPIDURAL ANAESTHESIA

目的观察腰硬联合麻醉行下肢骨科手术止血带对循环和代谢的影响。方法择期行下肢骨科手术患者20例,采用腰硬联合麻醉,术中上止血带,充气时间(99±18)min;压力(282±21.95)mmHg。测定止血带充气前、充气后30min、60min、90min及止血带放气后1,3,5,10,30min的平均动脉压(MAP)和心率(HR);以及止血带充气前及放气后5,10,30min血气指标和血乳酸盐含量。结果与充气前比,止血带充气期间MAP无明显变化,90min时HR增加。放气后MAP只在1min时下降,HR在各时点均增快。放气后各时点PaO2均较充气前明显降低,PaCO2只在5min时明显升高(P<0.01),各时点pH值、BE值、HCO3-均较充气前降低,P50在放气后各时点均较充气前升高。血清K+及乳酸盐在放气后各时点均明显升高。结论腰硬联合麻醉下使用止血带行下肢骨科手术可提供较完善的麻醉效果和稳定的血流动力学,一过性高CO2血症恢复较快,可适用于大多数人群。

Objective To approach the effect of tourniquet on circulation and metabolism during lower limb surgery under combined spinal- epidural anaesthesia（CSEA）. Methods 20 ASA Ⅰ-Ⅱ grade patients, aged 23-76 years old, underwent selective limb orthopedic surgery under CSEA. The duration of inflation was from 65 to 126 min, and the pressure of inflation was from 230 to 300 mmHg. Circulatory variables were measured before and 30, 60, 90 min after inflation of a pneumatic thigh tourniquet and 1, 3, 5, 10, 30 min after release of tourniquet. Arterial blood gas and blood lactate were measured before and 1, 3, 5, 10, 30 min after release of tourniquet. Results Compared with the values before tourniquet inflation, mean arterial pressure kept stable during inflation and HR increased only at 90 min after inflation（P〈0.01）. After tourniquet deflation, MAP decreased only at 1 min after inflation （P〈0.05） and HR increased at all time points. PaO2 increased at all time points. PaCO2 increased only at 5min after inflation （P〈0.01）. Arterial blood pH, base excess and HCO3 - decreased at all time points. P50, arterial plasma potassium and lactate concentrations increased at all time points after tourniquet release. Conclusion Under CSEA, limb surgery with the touniquet application can get satisfactory anaesthetic effect and stable hemodynamics. Recovery of transient hypercapnia after release of tourniquet is faster than general anaesthesia with mechanically- controlled ventilation.