全麻复合硬膜外阻滞在全髋置换手术中对患者循环影响的临床观察

Clinical Observation of General Anesthesia Combined with Epidural Anesthesia in Total Hip Replacement Surgery in Circulation Impact on Patients

目的 观察急性高容量血液稀释（AHHD）对全麻复合硬膜外阻滞下行全髋置换手术患者血流动力学的影响。方法 选择ASAⅠ～Ⅱ级,择期全髋置换术患者80例,随机分成全麻组（G组）和全麻符合硬膜外阻滞麻醉组（G/E组）,每组40例,两组患者均在全麻诱导完成后实施AHHD,经中心静脉将羟乙基淀粉200/0.5氯化钠注射液500 mL以40 mL/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（CD）、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AHHD前、AHHD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AHHD前、AHHD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AHHD完毕即刻、术毕和拔管时明显较AHHD前高（P〈0.05）。SVR在AHHD完毕即刻明显较AHHD前降低,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麻醉下行AHHD,应用于全髋置换术中可提高安全性。

Objective To investigate the effect of acute hypervolemic hemodilution（AHHD）on hemodynamics in patients who received total hip replacement with combined general and epidyral anesthesia. Methods 80 ASAⅠ-Ⅱ patients undergoing elective total hip replacement, were randomly divided into two groups, 40 each, general anesthesia group（group G）and combined general and epidural anesthesia group（group G/E）. After induction of anesthesia, AHHD were performed by central vein administering 500 mL hydroxyethyl starch 200/0.5 sodium chloride injection by 40 mL/min. The following parameters were recorded before and after AHHD： mean arterial pressure（MAP）, central venous pressure（CVP）, heart rate （HR）, as well as cardiac output（CD）, cardiac index（CI）and peripheral vascular resistance（SVR）from NICO noninvasive heart function monitor. Results MAP of patients were decreased after induction of anesthesia and increased during extubation. Compared with group G, the MAP is lower just before, after AHHD, finishing of surgery and extubation（P〈0.05）. HR were increased in both groups, whereas groups G is faster than group G/E in extubation（P〈0.05）. CI and CVP were increased just after AHHD, finishing of surgery and extubation（P〈 0.05）. SVR after AHHD is lower than before and it was recovered after surgery, SVP in group G/E is lower than group G. Conclusion AHHD is able to improve outcome during total hip replacement with combined general and epidural anesthesia.