Zhao Wei, Zhou Ran, Zhou Li-Ping, Li Cheng-Hui
Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Wai Ke Za Zhi. 2009 Jun 1;47(11):849-52.
To investigate the hemodynamic effects between the two established anesthetic managements: thoracic epidural anesthesia combined with general anesthesia (TEA + GA) as well as total intravenous anesthesia (TIVA).
Forty-four patients undergoing major abdominal operation were randomized to TEA + GA (n = 22) group or TIVA (n = 22) group. After thoracic epidural catheterization, the anesthesia induction and endotracheal intubation was made and a standard anesthesia procedure was administered for both groups. In TEA + GA group, the patients received thoracic epidural anesthesia (TEA) with 0.25% bupivacaine (bolus 0.5 mg/kg firstly and then infused continuously with 0. 2 ml x kg(-1) x h(-1)). While in TIVA group, the patients received 0.9% saline via epidural catheter just with the same bolus volume and same infusion rate as in TEA + GA group. The parameters monitored were as follows: ECG, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), central venous pressure, cardiac index (CI), systemic vascular resistance (SVR), pulse oximetry and PetCO2. Blood gas analysis was made as needed. The observation time for both groups was 90 min.
After epidural infusion of bupicacaine (TEA + GA group) or saline (TIVA group), SAP, DAP, HR and SVR in TEA + GA group were statistically decreased in comparing with the baseline, and SAP, DAP, MAP and SVR were also decreased significantly when compared with those in TIVA group (P < or = 0.05). However, CI and SV in TEA + GA group changed little and showed no statistical differences in comparing with those in TIVA group.
This study gives evidences that TEA in combination with GA had no negative effects on cardiac functions. The decrease of blood pressure may possibly be caused by the reduction of systemic vascular resistance.
探讨两种既定麻醉管理方式（胸段硬膜外麻醉联合全身麻醉（TEA + GA）以及全静脉麻醉（TIVA））之间的血流动力学效应。
44例接受腹部大手术的患者被随机分为TEA + GA组（n = 22）或TIVA组（n = 22）。在进行胸段硬膜外导管置入后，进行麻醉诱导和气管插管，并对两组实施标准麻醉程序。在TEA + GA组，患者接受0.25%布比卡因的胸段硬膜外麻醉（TEA）（先给予负荷剂量0.5 mg/kg，然后以0.2 ml·kg⁻¹·h⁻¹持续输注）。而在TIVA组，患者通过硬膜外导管接受0.9%生理盐水，推注量和输注速率与TEA + GA组相同。监测的参数如下：心电图、收缩压（SAP）、舒张压（DAP）、心率（HR）、中心静脉压、心脏指数（CI）、全身血管阻力（SVR）、脉搏血氧饱和度和呼气末二氧化碳分压。根据需要进行血气分析。两组的观察时间均为90分钟。
在硬膜外输注布比卡因（TEA + GA组）或生理盐水（TIVA组）后，与基线相比，TEA + GA组的SAP、DAP、HR和SVR有统计学意义的下降，与TIVA组相比，SAP、DAP、平均动脉压（MAP）和SVR也显著下降（P≤0.05）。然而，TEA + GA组的CI和每搏输出量（SV）变化不大，与TIVA组相比无统计学差异。
本研究表明TEA联合GA对心脏功能无负面影响。血压下降可能是由全身血管阻力降低所致。
