Crawford M E, Møiniche S, Orbaek J, Bjerrum H, Kehlet H
Department of Anesthesiology, Hvidovre Hospital, University of Copenhagen, Denmark.
Anesth Analg. 1996 Nov;83(5):1028-32. doi: 10.1097/00000539-199611000-00022.
Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were measured at supine rest, during orthostatic stress, and after walking prior to and 24, 48, and 72 h and 48 h postoperatively compared to preoperatively (P < or = 0.008); 16 vs 6 patients presented resting systolic BP values < 100 mm Hg (lower range, 70 mm Hg) post- versus preoperatively (P = 0.048). During orthostatic stress the decrease in systolic BP and concomitant increase in HR was similar post- versus preoperatively (BP, P > 0.3; HR, P > 0.34) and 12 vs 8 patient; (P = 0.45) experienced a systolic BP decrease > 20 mm Hg post- versus preoperatively. After walking, systolic BP was significantly lower postoperatively compared with preoperatively (P < or = 0.01). Epidural infusion was discontinued in three patients due to either persisting resting or orthostatic hypotension. There was no correlation between ASA classification, intraoperative bleeding, or postoperative dizziness and incidence of orthostatic hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients.
50例行结肠手术的患者接受了胸段硬膜外联合全身麻醉，术后持续硬膜外输注0.25%布比卡因和0.05mg/mL吗啡，4mL/h，共96小时，同时每日口服替诺昔康20mg。在术前以及术后24、48、72小时和48小时测量患者仰卧休息时、体位性应激期间和行走后的心率（HR）和动脉血压（BP），并与术前进行比较（P≤0.008）；术后与术前相比，分别有16例和6例患者静息收缩压值<100mmHg（下限为70mmHg）（P = 0.048）。在体位性应激期间，收缩压下降和心率随之增加的情况在术后与术前相似（BP，P>0.3；HR，P>0.34），分别有12例和8例患者（P = 0.45）术后收缩压下降>20mmHg。行走后，术后收缩压与术前相比显著降低（P≤0.01）。3例患者因持续静息或体位性低血压而停止硬膜外输注。美国麻醉医师协会（ASA）分级、术中出血或术后头晕与体位性低血压的发生率之间无相关性。结果表明，接受腹部手术并接受持续小剂量胸段硬膜外布比卡因-吗啡治疗的患者在休息和活动时血压会下降，但在大多数患者中，下降程度不会严重影响行走。
