静脉麻醉和腰-硬膜外麻醉对髋关节置换术患者血流动力学和血液流变学指标的影响

发布时间：2018-04-29 23:38

本文选题：髋关节置换术 + 静脉麻醉　；参考：《微循环学杂志》2016年04期

【摘要】：目的:比较髋关节置换术行静脉全麻和腰-硬膜外麻醉患者的血流动力学和血液流变学指标变化。方法:92例髋关节置换术患者按随机数字表法分为静脉全麻组和腰-硬膜外麻醉组,每组各46例。静脉全麻组行气管内插管后微量泵静脉给予瑞芬太尼(0.1-0.5μg/kg/h)和丙泊酚(4-6mg/h),腰-硬膜外麻醉组行L2-3腰-硬膜外穿刺给药予0.5%左布比卡因2ml。对比两组麻醉前(T0)、麻醉5min(T1)、麻醉30min(T2)及术后5min(T3)、30min(T4)的血流动力学和血液流变学指标以及药物起效、阻滞完成时间和麻醉并发症发生率的差异。结果:两组T0血流动力学及血液流变学指标差异无统计学意义(P0.05)。腰-硬膜外麻醉组T1、T2、T3、T4时血压(BP)、心率(HR)、血氧饱和度(SPO2)均明显高于静脉全麻组(P0.05),全血黏度、全血还原黏度、血浆黏度亦明显高于静脉全麻组(P0.05)。腰-硬膜外麻醉组内各时相的BP、HR、SPO2、全血黏度、全血还原黏度、血浆黏度均无明显差异(P0.05);而静脉全麻组内各时相上述各指标均存在明显差异(P0.05),T1-T4均低于T0(P0.05)。同时,腰-硬膜外麻醉组麻醉起效时间、阻滞完全时间短于静脉全麻组(P0.05)。两组均未发生药物不良反应和麻醉并发症。结论:髋关节置换术患者采用腰-硬膜外麻醉更合适。
[Abstract]:Objective: to compare the changes of hemodynamics and hemorheology in patients undergoing general intravenous anesthesia and spinal-epidural anesthesia after hip arthroplasty. Methods 92 patients with hip arthroplasty were randomly divided into general intravenous anesthesia group and spinal-epidural anesthesia group with 46 cases in each group. After endotracheal intubation, intravenous infusion of remifentanil 0.1-0.5 渭 g / kg 路kg / h and propofol 4-6 mg / h were performed in the general anesthesia group, and 0.5% levobupivacaine was given to the L2-3 lumbar epidural puncture in the spinal-epidural anesthesia group. The difference of hemodynamics, hemorheology, effect of drugs, time of completion of block and incidence of complications of anesthesia were compared between the two groups before anesthesia, 5 min after anesthesia, 30 min after anesthesia and 5 min after operation. Results: there was no significant difference in T 0 hemodynamics and hemorheology between the two groups (P 0.05). The blood pressure, heart rate and blood oxygen saturation in the spinal-epidural anesthesia group were significantly higher than those in the intravenous general anesthesia group (P 0.05). The whole blood viscosity, whole blood reduction viscosity and plasma viscosity were also significantly higher than those in the intravenous general anesthesia group (P 0.05). There was no significant difference in SPO _ 2, whole blood viscosity, whole blood reduction viscosity and plasma viscosity in all phases of Spinal epidural anesthesia group (P 0.05), but there were significant differences in each time phase above mentioned above in intravenous general anesthesia group (P 0.05) and T _ (1-T _ 4) were lower than that in T _ 0 P _ (0.05) T _ (0.05). At the same time, the onset time and complete block time of spinal-epidural anesthesia group were shorter than that of intravenous general anesthesia group (P 0.05). There were no adverse drug reactions and anesthetic complications in both groups. Conclusion: lumbar epidural anesthesia is more suitable for hip arthroplasty.
【作者单位】：北京中医医院顺义医院麻醉科;
【分类号】：R614

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