摘要
目的 观察硬膜外麻醉下 ,妇科腹腔镜手术患者在低CO2 气腹压和 15°头低脚高体位时肾素 血管紧张素系统 (RAAS)和肾小球滤过率 (GFR)的变化。方法 监测 2 0例患者气腹前、腹内压达 1 33～ 1 5 9kPa后 10、30、6 0分钟及解除气腹后 10分钟五个时点血浆肾素 (PRA)、血管紧张素Ⅱ (AⅡ )、醛固酮 (ALD)和 β2 微球蛋白 (β2 MG)的含量。其中 10例患者在相应五个时点行动脉血气分析。结果 气腹后各时点血浆PRA、AⅡ及 β2 MG含量均比气腹前降低 (与气腹前比 ,除PRA在气腹后 10分钟时P <0 0 5 ,其余均P >0 0 5 )。随着气腹时间的延长 ,各指标值均有逐步轻微增高的趋势。解除气腹后恢复到气腹初期水平。PaCO2 气腹后比气腹前增高 (P >0 0 5 ) ,并在气腹后 30分钟达到最高值。气腹后 30～ 6 0分钟 pH比气腹前明显降低 (P <0 0 5或P <0 0 1)。 结论 硬膜外麻醉能够抑制妇科腹腔镜手术CO2 气腹 (IAP1 33～ 1 5 9kPa)刺激所致的RAAS反应 。
Objective To investigate the changes of renin-angiotensin-aldosterone system (RAAS)and glomerular filtration rate(GFR) in epidurally-anesthetized patients undergoing gynecological laparoscopy with 15° head-down position and low insufflation pressure.Methods Twenty gynecological patients(ASA grade Ⅰ-Ⅱ)were studied during CO_2 insufflation with an intra-abdominal pressure of 10-12mmHg and 15° head-down position.Arterial blood samples were obtained for the measurements of serum concentrations of plasma renin activity(PRA),angiotensin Ⅱ (AⅡ),aldosterone(ALD) and β_2-microglobulin(β_2-MG)by radioimmunoassay at the following five time points:before insufflation,at 10min,30min and 60 min after insufflation respectively and after desufflation.Arterial blood gas analysis was made in 10 of the cases simultaneously.Results Compared with preinsufflation,there was no significant decrease in the plasma levels of PRA,AⅡ,ALD and β_2-MG during CO_2 pneumoperitoneum except for PRA at 10 min after insufflation(P<0.05).As the time of insufflation went on,the measurements above showed a tendency of slightly increase.The PaCO_2 during peritoneal CO_2 insufflation was increaseing (P>0.05)and reached its maximum at 30 min after insufflation.The pH values of 30～60 min after insufflation were significantly decreased as compared with that of before insufflation.Conclusion The epidural anesthesia may inhibit the response of RAAS to CO_2 insufflation pressure of 10-12mmHg and has no effect on GFR during gynecological laparoscopy.
出处
《临床麻醉学杂志》
CAS
CSCD
2001年第4期197-199,共3页
Journal of Clinical Anesthesiology
