不同麻醉方法对全髋置换术患者的血液流变学的影响临床.docVIP

不同麻醉方法对全髓置换术患者的血液流变学的影响临床观察 辽宁省人民医院麻醉科110016 尹美华张静蔡长华 目的：对比研究单纯全麻与硬膜外加全麻对全骯置换术患者的血液流变学的影响。方 法：16例ASA I?II级，行择期全髓置换术患者随机分为两组。I组为全麻组，II组为硬膜 外加全麻组，诱导前硬膜外给2%利多卡因5ml,有平面后行全麻诱导，全麻用药与I组相 同，术中用利多卡因硬膜外阻滞，每50min给药6?8ml,术后24h内用0. 5%布比卡因镇痛， I组术后肌注哌替噪镇痛。结果：两组血液流变学的主要差异：II组的血液还原粘度、血浆 粘度及纤维蛋白原浓度术中明显下降,术后恢复接近术前。I组这三项指标术中也明显下降， 但术后3天内均反跳明显高于术前。结论：硬膜外阻滞能更好地抑制应激反应，其对血流变 学的影响更有利于预防术后下肢静脉炎和静脉血栓的形成。 关键词 全身麻醉硬膜外麻醉血液流变学 The Clinic Research on Effects of Different Anesthetic Techniques onHaemorheology in Patients Undergoing Total Hip Replacement Yin Meihua, Zhang Jing, Chai Changhua. Department of Anesthesiology, The peopled Hospital of Liaoning Province、Shenyang 110016 ObjectiveiThe study was undertaken to compare the effects of general anaesthesia and epidural block plus general anaesthesia on haemorheology. Methods: Sixteen adult patients, ASA grade I ?II, scheduled for elective total hip replacement were divided randomly into two groups. Group H (n = 8), 5ml, 2% lidocaine was given epidurally before induction of anaesthesia, and every 50min 6?8ml was added after induction. The group I was not given epidural anesthisisa, and the general anaesthesia method of both groups was similar in induction and maintenance. In 24 houurs after operation, 0.5% bupivacaine was given epidurally in group 【【and pethidineim.in group I for pain relief. ResultsiThe blood reducing viscocity, plasma viscocity and concentration of fibrinogen were decreased markedly during operation in two groups. These index recovered to the level of preoperation on the third postoperative day in group H、but were higher than that in group I . Conclusion: As compared with the general anaesthesia, epidural anaesthesia may attenuate the endocrine responses to stress more effectively and improve haemorheology, which is helpful in preventing deep venous thrombosis postoperatively? Key words General anaesthesia Epidural anaesthsia Haemorehology 下肢骨科手术，特别是全轆置换术和股骨头置换手术后，深静脉炎和深静脉血栓的发生 率较i?]-[1-4]o血液流变学的改变是引起这一并发症的一个相关因素。本研究对比观察单纯全 麻与硬膜