硬膜外麻醉期间血浆容量变化对钙浓度的影响。

The effects of plasma volume variations on the calcium concentration during epidural anaesthesia.

作者信息

Kancir C B, Petersen P H, Wandrup J

出版信息

Acta Anaesthesiol Scand. 1987 May;31(4):338-42. doi: 10.1111/j.1399-6576.1987.tb02579.x.

DOI:10.1111/j.1399-6576.1987.tb02579.x

Abstract

The plasma variations of the ionized and total calcium concentration in relation to protein concentration and plasma volume were studied in 12 patients during epidural anaesthesia for transurethral prostatectomy. The most significant changes were noted during the onset of anaesthesia. From arrival in the operating theatre to start of operation, the plasma concentration of ionized calcium decreased from 1.28 (s.d. = 0.05) mmol/l to 1.22 (s.d. = 0.04) mmol/l and total calcium decreased from 2.39 (s.d. = 0.11) mmol/l to 2.17 (s.d. = 0.10) mmol/l. At the same time, however, the decrease in ionized calcium concentration and the increase in plasma volume were associated with a rise of 10.3% in the pool of free calcium ion in plasma. After the start of surgery, the plasma ionized calcium concentration remained almost unaffected throughout the rest of the study period. The total plasma calcium concentration as well as the total protein concentration remained stable during operation, only increasing after the end of surgery. The preoperative changes in the plasma calcium concentration may have been the result of both haemodilution and mobilization of calcium ions from its bone stores. Postoperatively, an increased urinary loss of calcium must have followed the administration of furosemide at the end of surgery.

摘要

在12例接受经尿道前列腺切除术硬膜外麻醉的患者中，研究了离子钙和总钙浓度的血浆变化与蛋白质浓度及血浆容量的关系。麻醉开始时出现了最显著的变化。从进入手术室到开始手术，离子钙的血浆浓度从1.28（标准差 = 0.05）mmol/L降至1.22（标准差 = 0.04）mmol/L，总钙从2.39（标准差 = 0.11）mmol/L降至2.17（标准差 = 0.10）mmol/L。然而，与此同时，离子钙浓度的降低和血浆容量的增加与血浆中游离钙离子池增加10.3%相关。手术开始后，在研究的剩余时间里血浆离子钙浓度几乎未受影响。手术期间血浆总钙浓度以及总蛋白浓度保持稳定，仅在手术结束后升高。术前血浆钙浓度的变化可能是血液稀释和钙离子从骨储备中动员的结果。术后，手术结束时给予呋塞米后必然导致钙的尿排泄增加。