Bonnet F, Touboul C, Picard A M, Vodinh J, Becquemin J P
Department of Anesthesia, Hôpital Henri Mondor, Creteil, France.
Ann Vasc Surg. 1989 Jul;3(3):214-9. doi: 10.1016/S0890-5096(07)60026-0.
The hemodynamic consequences of abdominal aortic surgery with infrarenal cross-clamping were studied in 21 patients randomized in two groups. In Group I (11 patients), neuroleptanesthesia was utilized, while Group II (10 patients) received thoracic epidural anesthesia at the T8-9 level. Hemodynamic measurements were performed using Swan-Ganz catheters during the surgical procedures in all patients, with special attention to the periods of clamping and unclamping of the abdominal aorta. The thoracic epidural anesthesia group was characterized by greater hemodynamic stability during surgery, while patients in the neuroleptanesthesia group had significant lability of blood pressure, heart rate, and cardiac index. Nevertheless, in the two groups of patients, it is suggested that cardiac function was unfitted to the tissue oxygen demand after unclamping of the aortic prosthesis because the saturation in oxygen of the mixed venous blood and an increase in arteriovenous difference in oxygen were documented. These results point out that, whatever the anesthesia technique, the critical period in abdominal surgery could be aortic unclamping.
对21例患者进行了分组研究，以探讨肾下交叉钳夹腹主动脉手术的血流动力学后果。将患者随机分为两组，第一组（11例）采用神经安定麻醉，第二组（10例）在T8-9水平接受胸段硬膜外麻醉。所有患者在手术过程中均使用Swan-Ganz导管进行血流动力学测量，特别关注腹主动脉钳夹和松开的时间段。胸段硬膜外麻醉组在手术期间血流动力学更稳定，而神经安定麻醉组患者的血压、心率和心脏指数有明显波动。然而，两组患者均显示，在主动脉假体松开后，由于混合静脉血氧饱和度和动静脉氧差增加，提示心脏功能不适应组织氧需求。这些结果表明，无论采用何种麻醉技术，腹部手术的关键时期可能是主动脉松开时。
