医用加压弹力袜或间歇式充气压力泵对截石位全麻患者术中血流动力学的影响

Effect of medical compression elastic stockings or intermittent pneumatic pressure pumps on intraoperative hemodynamics in patients in lithotomy position under general anesthesia

目的评价医用加压弹力袜或间歇式充气压力泵对截石位全麻患者术中血流动力学的影响。方法择期截石位全麻结直肠手术、妇科手术患者100例,手术时间>60 min,年龄30~59岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=50):压力泵组(PP组)和弹力袜组(ES组)。于入室(T0)、麻醉诱导后即刻(T1)、截石位5 min(T2)、30 min(T3)、术毕(T4)时记录SBP、DBP和HR,并记录血管活性药物的用量。结果与T0时比较,PP组T1~3时、ES组T1时SBP降低(P<0.05)。与PP组比较,ES组T2,3时SBP升高(P<0.05),而各时点DBP与HR差异无统计学意义(P>0.05);术中麻黄碱用量减少[(16±9)mg vs.(8±5)mg,P<0.05]。结论医用加压弹力袜对截石位全麻手术患者血流动力学的干扰较小,其安全性优于间歇式充气压力泵。

Objective To evaluate the effect of medical compression elastic stockings or intermittent pneumatic pressure pumps on intraoperative hemodynamics in patients in the lithotomy position under general anesthesia.Methods A total of 100 patients,aged 30-59 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective colorectal surgery or gynecological surgery in the lithotomy position under general anesthesia,with expected operation time>60 min,were divided into 2 groups(n=50 each)using a random number table method:pressure pump group(group PP)and elastic stocking group(group ES).After entering the operating room(T0),immediately after anesthesia induction(T1),at 5 and 30 min of the lithotomy position(T2,3)and at the end of surgery(T4),systolic and diastolic blood pressure(SBP,DBP)and heart rate(HR)were measured,and the requirement for vasoactive agents was recorded.Results Compared with the values at T0,SBP was significantly decreased at T1-3 in group PP and at T1 in group ES(P<0.05).Compared with group PP,SBP was significantly increased at T2,3 in group ES(P<0.05),no significant change was found DBP and HR at each time point(P>0.05),and the intraoperative consumption of ephedrine was reduced([16±9]mg vs.[8±5]mg,P<0.05).Conclusion Medical compression elastic stockings produces less interference in intraoperative hemodynamics in patients in the lithotomy position under general anesthesia,and its safety is better than intermittent pneumatic pressure pumps.