单纯全身麻醉及全身麻醉联合硬膜外阻滞对食管手术患者血流动力学.docVIP

单纯全身麻醉及全身麻醉联合硬膜外阻滞对食管手术患者血流动力学 　【摘要】 目的 观察单纯全身麻醉和全身麻醉联合硬膜外阻滞对食管手术患者血流动力学的影响。方法 35例择期胸科食管手术患者随机分为全身麻醉组(GA组，17例) 和全身麻醉+硬膜外阻滞组（GEA组，18例)。分别测定术前、术毕及术后24、48 h血流动力学相关参数。结果 ①毛细管血浆黏度及各切变率下全血黏度、全血还原黏度在术毕时均比术前明显降低（Plt;0.05,Plt;0.01)，术后48 h时基本恢复到术前水平，组间比较无差异。②红细胞刚性指数、聚集指数：GEA组除术毕比术前明显降低外(Plt;0.05，Plt;0.01），其余各时点无明显变化；GA组无明显变化。③2组红细胞变形指数和电泳指数在48 h内无明显变化。结论 单纯全身麻醉和全身麻醉联合硬膜外阻滞对术后的血黏度都具有一定的降低作用，但其作用一般不超过48 h。 【关键词】 全身麻醉；硬膜外阻滞；血流动力学 Abstract：Objective To investigate the influence of epidural analgesia and general anesthesia on hemodynamics in patients undergoing esophageal surgery. Methods 35 patients were randomly divided into two groups: general anesthesia group (group GA, n=17), general anesthesia combined epidural anesthesia group (group CEA, n=18). The hemodynamic parameters were monitored before anesthesia, at the end of operation as well as 24 and 48 hours postoperatively. Results 1. Compared with the parameters before anesthesia, the microvascular plasma and whole blood viscosity significantly decreased (Plt; 0.05, Plt; 0.01) at various shear rates in both groups at the end of operation, and returned to the baseline level 48 hours after operation. 2. The red blood cell rigidity and aggregation index of group GEA obviously decreased (Plt; 0.05, Plt; 0.01) at the end of operation. No changes were observed at the other time points as well as in GA group. 3. No evident changes in erythrocyte morphology and electrophoresis index were observed within the postoperative 48 hours in the two groups. Conclusion Both general anesthesia and combined anesthesia with epidural block can reduce the blood viscosity, but on the whole its effect does not exceed 48 hours. Key words:general anesthesia; epidural block; hemodynamics 深静脉血栓(DVT)是手术后的常见并发症，已知血液黏度等血流动力学方面的改变对静脉血栓的形成具有重要的影响。有报道骨科手术采用椎管阻滞麻醉有利于减少下肢血液瘀滞，术后DVT的发生率较全身麻醉低［1］；但对于胸科手术而言，硬膜外阻滞或全身麻醉能否因血流动力学的改变而影响术后血栓的形成仍存在争议。本研究采用上述2种麻醉方法，探讨不同麻醉方法选择对血流动力学的影响。 　　1 资料和方法 　　1.1 一般资料 　　35例择期胸科食管手术患者，ASA Ⅰ～Ⅱ级，年龄52～75岁，体重45～76 kg，随机分为全身麻醉(GA)组17例和