Reinhart K, Foehring U, Kersting T, Schaefer M, Bredle D, Hirner A, Eyrich K
Department of Anesthesiology and Intensive Care Medicine, Klinikum Steglitz, Free University of Berlin, West Germany.
Anesth Analg. 1989 Sep;69(3):360-9.
The effects of thoracic epidural anesthesia (TEA) on total body oxygen supply-demand ratio are complex due to potential influences on both O2 delivery (QO2) and consumption (VO2). One hundred and five patients undergoing abdominal aortic surgery were randomly assigned to one of three groups to compare the cardiovascular and metabolic responses associated with (1) thoracic epidural anesthesia plus light general anesthesia (group TEA); (2) general anesthesia with halothane (group H); and (3) neuroleptanalgesia (group NLA). Values of cardiac index (CI) and QO2 were less intraoperatively in the TEA group than in the H or NLA groups, while VO2 values were similar. VO2 during recovery was greater in both the TEA and NLA groups than in the H group. Consequently the oxygen supply-demand ratio (QO2/VO2) was less in the TEA group throughout the perioperative period and about 30% below baseline values during early recovery. At comparable VO2, CI and mixed venous O2 saturation were always less in the TEA group than in the NLA group. Heart rate was slowest intraoperatively during TEA, and stroke work was less with TEA than with NLA. As cardiac filling pressure and systemic vascular resistance did not differ among the three groups, reduced adaptation of CI to tissue O2 needs during TEA was attributed to negative inotropic and chronotropic effects of the sympathetic blockade. We conclude that in patients undergoing abdominal aortic surgery, TEA has no apparent advantage over general anesthesia.
由于胸段硬膜外麻醉（TEA）对氧输送（QO₂）和氧消耗（VO₂）均有潜在影响，其对全身氧供需比的影响较为复杂。105例接受腹主动脉手术的患者被随机分为三组，以比较与以下情况相关的心血管和代谢反应：（1）胸段硬膜外麻醉加浅全身麻醉（TEA组）；（2）氟烷全身麻醉（H组）；（3）神经安定镇痛（NLA组）。TEA组术中心脏指数（CI）和QO₂值低于H组或NLA组，而VO₂值相似。TEA组和NLA组恢复期间的VO₂均高于H组。因此，TEA组围手术期的氧供需比（QO₂/VO₂）较低，且在早期恢复期间比基线值低约30%。在可比的VO₂水平下，TEA组的CI和混合静脉血氧饱和度始终低于NLA组。TEA组术中心率最慢，且TEA组的每搏功低于NLA组。由于三组之间心脏充盈压和体循环血管阻力无差异，TEA期间CI对组织氧需求的适应性降低归因于交感神经阻滞的负性肌力和负性变时作用。我们得出结论，在接受腹主动脉手术的患者中，TEA相对于全身麻醉没有明显优势。
