全麻复合硬膜外麻醉患者林格氏溶液的容量动力学.pdfVIP

全麻复合硬膜外麻醉患者林格氏溶液的 容量动力学 端窑海张俊峰蒋豪碎张纲杨建乎 {摘要] 目的 通过确定全麻篮合硬膜外时麻醉林格氏榕液的容量动力学模型参数，评价硬膜 外复合企麻对晶体液扩容效应的影响。方法 择期行肝癌切除术怠者 20 例，随机分为 2 组:组 I 麻 醉读导前行扩容治疗，组 H 破膜外复合全麻诱导后行扩容治疗。扩容采用 30 mUkg 乳酸销林格氏溶 液(l且)恼速输注，30min 内输究，输注 LR 开始后 90 min 内每 5 mín 测定血红蛋白 (Hb)及红细胞压积 (Hct) ，并记录总尿量及血液动力学数据。用容锺动力学数学模型和物质守恒定律处理数据，获得结 果。结果 组 H 容量主增加援、容援扩张效率、输注结束时液体保留率均高于组 I(P0.05)。一级容 量动力学分析结果:组 I 目标容积(v)和消除率(k， )均太子组 I1 (P0.05)。工级容量动力学分析结 果:组 I 的 Vl ， k，、 k，均高于组 I1 (P0.05)。扩容后组 H 的平均动脉压、中心静脉压、心输出最均小 子组 1 (PO.05)。缔论 全麻复合硬膜外麻醉可提高晶体液的容量扩张效率。 {关键词] 补液疗法; 麻醉，余身; 麻醉，破膜外; 容量动力学 Volume kineüωof RJnger soluüon In paüents durlng gener植la刷览tbesia combln叫 with 叩idural blockade JI Fi胁hαi , ZHANG Junr户，尊 ， JIANG Hao ， 创 αl. 儒队￥mα附附Tù 0/ An时thesiology ， First 1\伊liated H ospital , S阳hou University , Suzhou 215仪焰 ， China [Abstra叫 Objec伽e To ìnvestigate the dístributìon and elimination of the fluíd infused before and during general an刷thesìa combined with epidural block using mathemlltical model of volume kinetics 棚.d mllss balance. Methods Twenty ASA 1 or n male patients aged 33-56 归嗡 weighing 51-77 kg undergoín事 elective resectíon of liver cancer were randomly dívìded into 2 groups (n 10 each): lactated Ringer s solution (RL) 30 ml kg - 1 was infused over 30 mín at 60 min before (group 1 ) or 10 mìn after (group II) inductìon of general anesthesia combined with epìdural block with 0.25% bupìvacaíne 8-10 ml. 叽le patients were unpremedicated. Epidural cathe协r was placed at T.8 inter骂pace before induction of general anesthesìa and correct placement w阳 confirmed by a test do翩。f 2 % lidocaìne 3-5 ml. Arterial and CVP lines were established before anesthesia and cardìac output ( CO) , cardiac index (CI) and thoracìc water index were measured using 4 electrode impedance cardiogram. General anesthesia was induced with midazolam , thìopental , fentanyl and succinyl choline and maintained with isoflurane and intermìttent ìv boluses of vecuronium and fentanyl. Blood s刷nples were taken eveη5 mìn during the 90 mìn afte