摘要
目的探讨连续腰麻(CSA)对老年患者围术期血液流变学状态的影响。方法择期行下腹部或下肢手术的老年患者40例,ASAⅠ～Ⅲ级,随机分为连续腰麻组(CSA组)和连续硬膜外阻滞组(CEA组,对照组),每组20例。CSA组常规行连续腰麻穿刺置管,给予0.375%布比卡因重比重液,CEA组常规行连续硬膜外穿刺置管,给予试验量2%利多卡因3ml和追加0.75%罗哌卡因8～10ml,两组患者麻醉平面均控制在胸10以下。分别于麻醉前(T0)、麻醉后1h(T1)、术毕(T2)、术后24h(T3)、术后48h(T4)各时间点采血行血液流变学检测。结果CSA组血浆黏度T2-T3降低(与T0比较,P<0.05或0.01),全血低切黏度T3-T4低于T0(P均<0.01)、全血中切黏度T2-T4均低于T0(P<0.05或0.01),全血高切黏度T3-T4低于T0(P<0.05或0.01);CEA组血浆黏度T1-T3降低(与T0比较,P<0.05或0.01),全血低切黏度T2-T3低于T0(P<0.05或0.01)、全血中切黏度仅T3低于T0(P<0.01),全血高切黏度T3-T4低于T0(P<0.05);上述各指标各时点组间比较差异无统计学意义。结论连续腰麻同样可以改善老年患者血液流变学状态。
Objective To explore the effect of continuous spinal anesthesia （CSA） on perioperative hemorheology in elderly patients. Methods Forty ASA Ⅰ -Ⅲ patients （21 males, 19 females） aged 65 -90 years undergoing elective lower limb or bythus operations were randomized to one of two groups： CSA group （n =20） and continuous epidural anesthesia （CEA） group （control group） （n = 20）. All the patients were premedicated with intramuscular injection of diazepam 5 mg and scopolamine 0.5 mg. CSA was performed at L2/3 or 3/4 interspace. The patients received a 27 gauge continuous spinal catheter, which was threaded through a 22 gauge epidual needle into subarachnoid space. Hyperbaric 0. 375% bupivacaine solution （0.75% bupivacaine： 10% glucose solution = 1 ： 1 ） 0.5 - 1.0 ml was injected. If analgesia did not reach TIO after 5 - 10 min the same dose was given again. In CEA group epidural catheter was placed at L2/5 or 3/4. A test dose of 3 ml of 2% lidocaine was injected and then 0.75% ropivacaine 8 - 10 ml was injected into the epidural space. Hemorheological parameters were detected at following time points： before anesthesia （ T0 ）, 1 h after anesthesia （ T1 ）, at the end of surgery （ T2 ）, 24 h （ T3 ） and 48 h （ T4 ） after the operation. Results In CSA group, the plasma viscosity expressed a decrease from T2 to T3, and the whole blood viscosity was decreased from T3 to T4 at low shear rate, T2 to T4 at moderate shear rate, and T3 to T4 at high shear rate. In CEA group, the plasma viscosity expressed a decrease from T1 to T3, and the whole blood viscosity was decreased from T2 to T3 at low shear rate, only at T3 at moderate shear rate, and T3 to T4 at high shear rate. The fibrinogen was decreased from T1 to T4 in CSA group, and T2 to T4 in CEA group. The crythrocyte aggregation was decreased from T3 to T4 in CSA group, and T2 to T4 in CEA group. Conclusion CSA can also improve the state of hemorheology of elderly patients like CEA, which is beneficial to decrease the ratio of the complication of deep vein thrombus.
出处
《临床外科杂志》
2008年第10期704-706,共3页
Journal of Clinical Surgery
关键词
麻醉
脊髓
血液流变学
老年患者
anesthesia, spinal
hemorheology
elderly patient
