控制性低血压技术在坐位下肩关节镜手术的应用

The application of controlled hypotension during shoulder arthroscopic surgery

目的探讨坐位（“沙滩椅”体位）下肩关节镜手术中行控制性低血压技术对患者的安全性。方法12例择期行肩关节镜手术患者，摆“沙滩椅”体位。术中以尼卡地平行控制性低血压，维持平均动脉压于60～65mmHg。分别在麻醉前，坐位前，坐位即刻，输入血定安后，降压30min、1h，结束后30min时记录心率、平均动脉压、中心静脉压（CVP）、pH值、PaO2、PaCO2、血液碱剩余（BE-B）值及尿量、清醒时间。结果在坐位时，CVP明显下降（P〈0．05），但经过补充血容量处理后，CVP可回复至平卧时水平。由于气管插管后吸入氧浓度增加，PaO2明显增高（P〈0．01）。控制性低血压期间平均动脉压明显低于麻醉前（P〈0．01）。结论坐位使得手术操作便利，患者生命体征平稳，控制性低血压技术在“沙滩椅”体位关节镜手术中对患者安全可靠。

Objective To evaluate the clinical safety of controlled hypotension during shoulder arthroscopic surgery in the sitting position. Methods Tweleve patients scheduled for shoulder arthroscopic surgery were anesthetized with remifentanyl - propofol-vecuronium after intravenous induction. All patients were administered with the indwelling radial artery cannula and right intrajugular venous catheter before sitting position. All patients were bandaged on chest with abdomen and two legs before the beach-chair position. HR, MAP, CVP, pHa, PaCO2 , PaO2 and BE-B were recorded. 5 min before operation nicardipine induced hypotension was started from 10-30 μg/（ kg · min） and maintained with 0.5-6 μg/（ kg ·min） and then adjusted to control MAP to 50-65 mm Hg. The detection time points were before anesthesia induction, before sitting position, immediately and after gelfusine infusion at sitting position, 30 min and 60 min after hypotension, 30 min after hypotension was over. Results CVP dropped immediately after sitting position （ P 〈 0.05 ） but restored to normal level after infusing gelfusine. During anaesthesia and operation there were no changes in artery PH, PaCO2 and BE-B , whereas PaO2 was kept at high level after induction of anesthesia and during operation （P 〈 0.01 ） . MAP decreased significantly during hypotension phase（ P 〈 0.01 ）. Conclusion The technique of controlled hypotension during shoulder arthroscopic surgery at the beachchair position is safe and reliable.