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1、不同麻醉方法对全醜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髓置换术患者的血液流变学的影响。方法：16例ASAI〜II级，行择期全覩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，诱导前硬腹外给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组术后肌注哌替除镇痛。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
2、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天内均反跳明显髙于术前。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TheClinicResearchonEffectsofDifferentAnestheticTechniquesonHaemorheologyinPatientsUndergoingTotalHipReplacementYinMeihua,ZhangJing,ChaiChanghua.Depar
3、tmentofAnesthesiology,ThepeopledHospitalofLiaoningProvince,Shenyang110016ObjectiveiThestudywasundertakentocomparetheeffectsofgeneralanaesthesiaandepiduralblockplusgeneralanaesthesiaonhaemorheology.Methods:Sixteenadultpatients,ASAgradeI〜II,scheduledforelectivetotalhip
4、replacementweredividedrandomlyintotwogroups.GroupII(n=8),5mL2%lidocainewasgivenepidurallybeforeinductionofanaesthesia,andevery50min6〜8mlwasaddedafterinduction・ThegroupIwasnotgivenepiduralanesthisisa,andthegeneralanaesthesiamethodofbothgroupswassimilarininductionandma
5、intenance.In24houursafteroperation,0.5%bupivacainewasgivenepidurallyingroupIIandpethidineim.ingroupIforpainrelief.Results:Thebloodreducingviscocity,plasmaviscocityandconcentrationoffibrinogenweredecreasedmarkedlyduringoperationintwogroups.Theseindexrecoveredtotheleve
6、lofpreoperationonthethirdpostoperativedayingroupII,butwerehigherthanthatingroupI.Conclusion:Ascomparedwiththegeneralanaesthesia,epiduralanaesthesiamayattenuatetheendocrineresponsestostressmoreeffectivelyandimprovehaemorheology,whichishelpfulinpreventingdeepvenousthro
7、mbosispostoperatively.KeywordsGeneralanaesthesiaEpiduralanaesthsiaHaemorehology卜•肢骨科手术，特别是全競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高口~心。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外阻滞加全麻对全髓置换术患者的血液流变学的影响。1材料与方法1.1病例选择选ASAI〜II级行全髓置换手术患者16例，随机分为两组，每组8例，年龄50〜75岁，每组均为男3例、女5例，无严重心血管疾病及血液系
8、统疾病，术前血常规检查正常。1.2麻醉方法术前30min肌注哌替®50mg>异丙嗪25mg、东億著碱0.3mgo两组全麻诱导均用芬太尼2~2.5ug/kg、硫喷妥钠6〜8mg/kg、维库浪钱60ug/kg、气管插管后麻醉维持用0.8%〜1.0%异氟讎、50%〜6
