扩容治疗对老年患者血液动力学和血管外肺水的影响

Effects of volume preloading on hemodynamics and extravascular lung water in geriatric patients

目的 探讨术前扩容对老年患者血流动力学和血管外肺水的影响。方法 4 0例ASAⅠ～Ⅱ级的老年择期肝癌手术患者 ,随机分成术前扩容组 (A组 ,n =2 0 )和非扩容组 (B组 ,n =2 0 ) ,均选用硬膜外阻滞复合全身麻醉。在诱导前 1 5h ,A组静脉输注乳酸钠林格液 2 0ml kg ,羟乙基淀粉氯化钠 (6 %HES) 10ml kg ,B组输注 8～ 10mg kg乳酸钠林格液。两组全麻诱导前经硬膜外导管内注入 0 5 %布比卡因 4ml,待阻滞平面确切后静脉诱导。采用PiCCO监护仪连续监测并记录平均动脉压 (MAP)、心率 (HR)、心脏指数 (CI)、周围血管阻力 (SVR)、胸内血容量 (ITBV )和血管外肺水(EVLW )。结果 硬膜外麻醉后 ,两组的MAP、HR和CI无显著性改变 (P >0 0 5 ) ,而SVR则降低(P <0 0 5 ) ,B组的EVLW和ITBV显著减少 (P <0 0 5 ) ,A组扩容后 ,EVLW和ITBV无显著性改变 (P >0 0 5 ) ;气管插管前后 ,A组的MAP、HR、CI、SV和SVR与基础值比较无显著性差异 (P >0 0 5 ) ,而B组的上述指标则明显降低 (P <0 0 5 )。手术结束时 ,两组的血流动力学参数和血管外肺水无差异 (P >0 0 5 ) ,与基础值比较亦无显著性差异。结论 硬膜外阻滞复合全身麻醉 ,术前扩容有利于维持麻醉中血流动力学的稳定。术前增加的液体量 ,并未造成术中和术后血管外?

Objective To assess the effects of volume preloading on hemodynamics and extravascular lung water in elderly patients undergoing elective liver cancer operation under combined epidural and general anesthesia Methods Forty ASA Ⅰ Ⅱ patients (65 72 years) scheduled for elective elective liver cancer operation under combined epidural and general anesthesia were randomly divided into two groups: volume preloding group ( group A ,n=20) and group ( group B,n=20) The patients were premedicated with intramuscular phenobarbital sodium 0 1mg and atropine 0 3mg Epidural catheter was placed at T 8 9 and 0 5% bupivacaine 4ml was given before induction of general anesthesia Anesthesia was induced with fentanyl 4μg/kg,thiopentone 5mg/kg and succinycholine 2mg/kg After tracheal intubation the patients were mechanically ventilated P ET CO 2 was maintained between 35 40mm Hg Anesthesia was maintained with inhalation of 60% N 2O, intermittent intravenous boluses of fentanyl and vecuroinum and epidural bupivacaine In group A, patients received lactated Ringer solution 20ml/kg and hydroxyethyl starch solution (HES) 10ml/kg,1 5h before induction of general anesthesia In control group, patients received lactated Ringer solution 8 10ml/kg Internal jagular vein was cannulated for CVP monitoring and thermal dilution catheter was placed via femoral artery and connected with PICCO device ECG, MAP, HR, CVP, CI, SVR, intrathoracic blood volume(ITBV) and extravascular lung water (EVLW) were continuously monitored during the operation Results Demographic data were comparable between the two groups In groups A patients received more fluid [(4266 7±764 4)ml] than those in group B [(2725 5±262 9)ml] After epidural administration of 0 5% bupivacaine 4ml, there was no significant decrease in MAP,HR and CI (P>0 05) while SVR decreased significantly (P<0 05) as compared with the baseline values in both groups In group A there was no significant increase in EVLW after volume preloading as compared with baseline value After induction of general anethesia there was not significant decrease in MAP,HR, and CI as compared with baseline value (P>0 05) in group A; while in group B MAP, HR and CI decreased significantly (P<0 05) During operation there was no significant difference in ITBV and EVLW between the two groups Conclusions Crystalloid and colloid fluid preloading can prevent hypotension associated with epidural block compared with general anesthesia in geriatric patients and is beneficial for maintaining hemodynamic stability without increasing EVLW