高龄患者硬膜外阻滞期间用硝普钠降压对血管紧张素-Ⅱ和精氨酸加压素的影响

Plasma Angiotensin-Ⅱ、Vasopressin During Nitroprusside Induced Hypotension and Epidural Anesthesia in Elder Patients

目的 研究硬膜外阻滞前后使用硝普钠降压对血管紧张素 -Ⅱ (A -Ⅱ )、精氨酸加压素 (AVP)水平的改变及临床意义。方法 择期手术患者 40例 ,平分为两组 :组Ⅰ (n =2 0 )为胸段硬膜外阻滞 (TEA) ,组Ⅱ (n =2 0 )为腰段硬膜外阻滞 (LEA)。在硬膜外阻滞前后分别应用硝普钠控制性降压 (DH) ,使MAP降低 3 0 % (和基础值相比 ) ,并维持 15min。测定A -Ⅱ、AVP的浓度。结果 组Ⅰ在阻滞前低血压期间血浆中A -Ⅱ浓度明显增高 (P <0 .0 1) ,AVP浓度无明显增高 (P >0 .0 5 ) ,在阻滞后低血压期间血浆AVP浓度明显增高 (P <0 .0 1) ,而AⅡ无明显增加 (P >0 .0 5 )。组Ⅱ在阻滞前低血压期间血浆中AⅡ浓度明显增高 ,AVP浓度无明显增高 ;在阻滞后低血压期间血浆AVP和AⅡ浓度均明显增高 (P <0 .0 1)。结论 高龄患者硬膜外阻滞前低血压时A -Ⅱ作用增加 ,而TEA期间AVP维持血压的作用增加 ,LEA期间A

Objective To study the effect of Angiotensin-Ⅱ (A-Ⅱ)、 Vasopressiin (AVP) during nitroprusside induced hypotension and epidural anesthesia in elder patientsre.Methods Forty elder patients undergoing selective surgery were divided into two groups,in the patients in group Ⅰ ( n =20) thoracic epidural anesthesia (TEA) was conducted,in the patients in group Ⅱ ( n =20) lumbar epidural anesthesia (LEA) was conducted.The plasma angiotensin-Ⅱ,Vasopression were measured before and during epidural anesthesia combined hypotension.Result The plasma AⅡ was increased significantly in two groups ( P <0.01) during hypotension alone.However,there was no change for plasma AⅡ,AVP was increased significantly during combined TEA and hypotension.The plasma AⅡ and AVP was increased significantly during combined LEA and hypotension.Conclusion The effect of AⅡ is increased before epidural anesthesia.However,the effect of AVP increases during hypotension and TEA.The effect of AⅡ and AVP increases during hypotension and LEA.