全麻复合硬膜外阻滞对老年全髋置换术患者血流动力学的影响

Effects of combination of general and epidural anesthesia on hemodynamics during operation in the elderly patients of total hip replacement.

目的观察全麻复合硬膜外阻滞对全髋置换术患者急性高容量血液稀释(AHH)的血流动力学的影响。方法选择ASA I^II级,择期全髋置换术患者40例,随机分成全麻组(G组)和全麻复合硬膜外阻滞组(G/E组),每组20例。两组患者均在全麻诱导后实施AHH,经中心静脉将6%羟乙基淀粉(贺斯)以50ml/min输注完毕。术中采用NICO无创心功能监护仪连续监测心排血量(CO)、心脏指数(CI)和外周血管阻力(SVR),同时监测平均动脉压(MAP)、中心静脉压(CVP)和心率(HR)。分别在AHH前、AHH完毕即刻、术毕和拔管时记录上述数据。结果麻醉后患者的MAP均降低,而在拔气管导管时MAP均升高;在AHH前、AHH完毕即刻、术毕和拔管时G/E组的MAP较G组低。两组患者的HR在拔管时均较快,而且在拔管时G组较G/E组快(P<0.05)。两组患者的CI和CVP在AHH完毕即刻、术毕和拔管时明显较AHH前高(P<0.05)。SVR在AHH完毕即刻明显较AHH前降低(P<0.05),术毕又基本恢复;G/E组患者的SVR较G组低(P<0.05)。结论全麻复合硬膜外阻滞可以提高全髋置换术中老年患者行AHH的安全性。

Objective To observe the influences of combined general and epidural anesthesia on hemodynamics. Methods 40 patients （ASAI-II） undergoing elective total hip replacement were enrolled in this study. The patients were randomly divided into two groups, general anesthesia（G group, n = 20） and combined general and epidural anesthesia（G/E group, n = 20）. AHH was performed with 6% hetastarch at a rate of 50 ml/min by skin incision. Radial artery was cannulated for direct BP monitoring and internal jugular vein was cannulated for CVP monitoring. Cardiac output（CO）, cardiac index（CI）, SVR and HR were continuously monitored using noninvasive measurement of cardiac output （NICO）. Results Compared with the baselines, in both groups after anesthesia , MAP decreased significantly（P〈0. 05）. MAP decreased significantly in G group compared with G/E group（P〈0. 05）. HR increased significantly at extubation（P〈0. 05） and HR increased significantly in G group compared with G/E group at extubation（P〈0. 05）. CVP and CI increased and SVR decreased significantly after AHH in two groups as compared with those before AHH. SVR decreased significantly in G/E group compared with G group（P〈0. 05）. Conclusion The reliability of patients of total hip replacement with AHH can be increased by combined of general and epidural anesthesia.