高原地区静脉麻醉对宏循环和微循环的影响

Effects of intravenous anesthesia on patients' macro-and microcirculation in plateau region

目的观察高海拔地区静脉麻醉对宏循环和微循环的影响。方法前瞻性选择高海拔地区> 3 000米至低海拔地区(2 100米)择期行全身静脉麻醉胆囊切除术患者60例患者,观察麻醉诱导前(T0)、麻醉诱导后未插管前(T1)、插管后即刻(T2)、手术结束时(T3)的心脏指数(CI)、每搏指数(SVI)、血管外周阻力指数(SVRI)、脉压差变异率(PPV)、平均动脉压(MAP)、脉搏灌注指数变异度(PVI)、脉搏灌注指数(PI)。结果 SVI、SVRI、CI在T1、T2、T3时间段无统计学差异(P> 0. 05)。MAP在T1、T2时间段相比T0明显下降,差异有统计学意义(P <0. 05)。PPV在T1、T2、T3时间段相比T0明显升高,差异有统计学意义(P <0. 05)。PI在T1、T2时间段相比T0明显升高,有统计学差异(P <0. 05)。PVI在T1、T2、T3时间段相比T0明显升高,差异有统计学意义(P <0. 05)。结论在高原地区静脉麻醉时宏循环心功能的指标SVI、SVRI、CI变化不明显,MAP有下降,宏循环液体灌注指标PPV有升高;微循环末梢灌注指标PI、PVI有升高。在麻醉诱导前进行液体预输注可稀释血液,同时改善患者手术期间微循环的灌注。PI和PVI用于评价局部和全身组织中血容量状况,使脉搏氧参数评价循环功能更突出。

Objective To observe the effects of intravenous anesthesia on macro-and microcirculation for patients in plateau region.Methods 60 cases of patients undergoing general anesthesia for cholecystectomy at high altitudes(from 2 100 m to>3 000 m)were observed regarding their cardiac index(CI),stroke volume index(SVI),peripheral vascular resistance index(SVRI),differential pulse pressure variation rate(PPV),mean arterial pressure(MAP),pulse perfusion index variation(PVI),pulse perfusion index(PI)before anesthesia induction(T0),before intubation(T1),immediately after intubation(T2)and at the end of surgery(T3).Results SVI,SVRI,CI at T1,T2,T3 period showed no significant difference(P>0.05).MAP at T1 and T2 significantly decreased than at T0(P<0.05).PPV and PVI at T1,T2 and T3 significantly increased than at T0(P<0.05).PI at T1 and T2 significantly increased than at T0(P<0.05).Conclusion In high altitude area,macrocirculation indicators regarding heart function such as SVI,SVRI and CI showed no obvious difference.Microcirculation indicators regarding perfusion showed differences.MAP decreased,PPV increased,PI and PVI increased compared with pre-surgical condition.Liquid infusion prior to anesthesia induction can dilute blood and improve microcirculation perfusion during surgery.PI and PVI can be used to evaluate local and systemic blood volume and promote arterial oxygen parameters'surveillance on circulatory system.