多模式预处理麻醉初期血流动力学紊乱临床对比研究

Clinical comparative study of multi-mode pretreatment for early stage of anesthesia hemodynamics disorder

目的对比分别应用胶体(盈源200/0.5)、晶体(0.9%生理盐水)、胶体-晶体混合、药物(参附),四种方法预处理麻醉初期血流动力学紊乱临床效果。方法800例择期手术病人随机分为四组:胶体组(A组)200例,晶体组(B组)200例,晶体-胶体组(C组)(按1∶1比例)200例,药物组(D组)200例。A、B、C组病人按6 ml/g于入室后静脉输入,要求在麻醉初期用药前注入。D组将参附注射液50-70 ml加入100 ml生理盐水中输入,时间同A、B、C组。设立对照组不给予任何处理。记录预注前、预注15 min3、0 min4、5 min病人的收缩压,舒张压,平均动脉压,心率,脉搏血氧饱和度,动态心电图及临床症状。结果四组均对麻醉引起的循环紊乱有预防作用,优于对照组(P<0.05或P<0.01)。胶体组在循环保护时间上明显优于晶体组(P<0.05)。对于全身麻醉方式药物组循环保护作用优于补液组(P<0.01)。结论麻醉用药前预处理能够防止或减轻因麻醉引起的血容量相对不足,从而使麻醉初期血流动力学平稳。

Objective To compare the clinical effect of colloid （hydroxyethyl starch （200/0.5） and sodium chloride injection）, crystal （0.9%saline）,colloid-crystal and medicine （Shenfu） as pretreatment for early stage of anesthesia hemodynamics disorder. Methods A total of 800 patients undergoing selective operation were randomly divided into four groups：colloid group （group A） 200 cases,crystal group （group B） 200 cases,colloid- crystal group （group C） （in the proportion of 1 to 1） 200 cases and medicine group （group D） 200 cases. Patients in group A, B and C were vein autotransfusion after entering the operation room, before administration at tile beginning of anaesthesia. Patients in group D were injected of Shenfu in a dosage of 50 - 70 ml added into normal saline 100ml, the injection time was the same with group A, B and C. And set up a control group which without any treatment. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP）, heart rate, pulse oxygen saturation, dynamic electrocardiogram and clinical symptoms were recorded before injection, and preliminary injection of 15 min, 30 min and 45 min. Results All four groups had preventive effect on circulation disorder caused by anaesthesia, superior to the control group （ P 〈 0.05 or P 〈 0.01 ）. Colloid group was significantly higher than crystal.group in circulation protection time （ P 〈 0. 05）. As for general anesthesia, medicine group is better than fluid infusion group in protection circulation （ P 〈 0.01 ）. Conclusion Pretreatment before anaesthesia can prevent or reduce relative shortage of blood volume caused by anaesthesia, makes the hemodynamics in early stage of anesthesia stable.