肺外科手术；麻醉；血液动力学过程；参附注射液

EFFECT OF SHENFU INJECTION ON HEMODYNAMICS IN PATIENTS UNDERGOING LOBECTOMY OF LUNG BY COMBINEDEP1DURAL BLOCK AND GENERAL ANESTHESIA

目的探讨参附注射液对硬膜外阻滞复合全麻下肺叶切除术术中血流动力学指标的影响。方法60例拟在胸段硬膜外阻滞复合全麻下行肺叶切除术病人，年龄50~80岁，ASA分级Ⅱ～Ⅲ级，随机双盲法分为参附组及对照组各30例。参附组在麻醉诱导前给予参附注射液1．5mL／kg加入生理盐水至250mL输注；对照组同速输注等量的生理盐水。观察指标：①诱导前（T0）、诱导后5min（T1）、手术探查时（T2）、单肺通气30min（T3）、单肺通气60min（T4）、关胸前冲洗胸腔时（rrs）及术毕（T5）的平均动脉压（MAP）、心率（HR）、中心静脉压；②术中血管活性药物的使用情况、液体人量、出血量、尿量及手术时间；③麻醉期间罗哌卡因、丙泊酚、芬太尼、维库溴铵用量。结果与对照组相比，参附组MAP、HR在T1、T2、T3、T4、T5时升高（t=2．089－2．678，P〈O．05），麻黄碱、阿托品的使用量及输液总量减少（t=2．818-3．525，P〈0．01），其他观察指标两组比较差异无显著意义（P〉0．05）。结论参附注射液对胸段硬膜外阻滞复合全麻下肺叶切除术术中血流动力学指标具有一定的稳定作用。

Objective To investigate the effect of Shenfu injection on hemodynamics in patients undergoing lobectomy of lung by combined thoracic epidural block （TEB） and general anesthesia （GA）. Methods A double blind trail was conducted in 60 patients, age 50-80 years old, ASA grades Ⅱ - Ⅲ, undergoing lobectomy of lung by applying combined TEB and GA. The patients were evenly randomized to Shenfu injection group and control group. For patients in the Shenfu injection group, 1.5 mL/ kg of Shenfu injection diluted with 250 mL saline were given before anesthesia introduction, for those in the control group, an equal volume of saline was infused at the same rate. The following indexes were observed： （D MAP, HR and CVP at the time before an- esthesia introduction （T0）, 5 minutes after the introduction （T1）, at operations research （Tz）, after one-lung ventilation for 30 minutes （T3）, after one-lung ventilation for 60 minutes （T4）, at irrigating the thoracic cavity before closing the operative inci- sion （T5） and upon completion of the surgery （T6）. （~） The dosage of vasoactive drugs used at surgery, the amount of intraopera- rive fluid transfusion, blood loss, urinary volume and operation time. （~） The dosage of ropivacaine, propofol, fentanyl and vecuro- nium used during the anesthesia. Results Compared with the control group, MAP and HR in Shenfu injection group were in- creased at the time of T1, T2, T3, T4 and Ts （t= 2. 089- 2. 678,P〈（0. 05）, the dosage of atropine, and ephedrine, and the amount of intraoperative transfusion were lower （t=2. 818-3. 525 ,P〈（0.01）, as for the other observation indexes, no significant differences were noted （P〈0.05）. Conclusion The application of Shenfu injection in combined TEB and GA plays a certain role to stabilize hemodynamics in patients undergoing lobectomy of lung.