APCO监测全麻复合胸段硬膜外阻滞对胸科手术血流动力学的影响.docVIP

APCO监测全麻复合胸段硬膜外阻滞对胸科手术血流动力学 的影响 李季 陈萍 高进 400016 重庆，重庆医科大学附属第一医院麻醉科摘要 观察全麻复合胸段硬膜外阻滞对胸手术血流动力学的影响。0例拟行食管癌或肺癌根治术患者,随机分为全麻组和全麻复合胸段硬膜外阻滞组（II。采用Flo Trac/Vigileo系统监测麻醉诱导前、麻醉诱导后10min、麻醉诱导后30min0min、0min及术毕各时点的MAP，HR，SV，SVI，CO，CI，SVV，SVR和SVRI，并根据术中血气及CO值计算氧合（DO2）和氧合指数（DO2I）；记录每小时补液量，量和出血量，计算输液总量。术后6、12、24、48小时随访视觉模拟评分（VAS）及术后并发症发生率。与麻醉诱导前比较，两组诱导后10分钟MAP，HR，SV，SVI，CO，CI，SVR和SVRI均明显降低 (P0.05)； MAP, SV，SVI，CO，CI，SVR和SVRI仍显著降低(P0.05)。，II组各血流动力学参数明显小于I组(P0.05)，SVV明显大于I组。两组术中DO2，DO2I较麻醉前均明显降低(P0.05)，至术毕均回升至麻醉前水平；单肺通气期间两组患者比较，II组DO2 ，DO2I明显小于I组 (P0.05)。术后镇痛效果及VAS评分，II组I组(P0.05)。全麻复合胸段硬膜外阻滞血流动力学的影响更明显临床中应注意。 [关键词Flo Trac/Vigileo系统，连续心排血量监测，胸段硬膜外阻滞，血流动力学R614.2 Effect of General Anesthesia Combined Thoracic Epidural Block on Hemodynamics in Thoracic Operation With Arterial Pressure-based Cardiac Output System LI Ji, CHEN Ping,GAO Jin , XIANG Shiqi ,Dai Heng,You Jiyue. Department of Anesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016 , China [ABSTRACT] Objective To observe the effect of general anesthesia combined with thoracic epidural block on hemodynamics in the patients undergoing thoracic operation. Methods forty adult patients undergoing thoracic surgery, were randomlly allocated to general anesthesia group(I group) and general anesthesia combined thoracic epidural block group(II group). MAP, HR, SV, SVI, CO, CI, SVR, SVRI and SVV were monitored through Flo Trac/Vigileo system before anesthesia, 10min after anesthesia induction, 30min after anesthesia, 30min, 60min after one-lung ventilation and the end of surgery, meanwhile arterial blood gas parameters were determined, and DO2 and DO2I were calculated. The volume of fluid infusion in every hour, intraoperative total volume, urine and blood loss were recorded. VAS scores and the incidence rate of complication after operation were also observed. Results In the two groups, MAP, HR, SV, SVI, CO, CI, SVR and SVRI 10 minutes after anesthesia induction were decreased compared with that before