中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (31): 5773-5776.doi: 10.3969/j.issn.1673-8225.2011.31.017

• 肾移植 kidney transplantation • 上一篇    下一篇

合并心力衰竭尿毒症肾移植患者采用腰-硬联合麻醉的安全性

张彩琴，吴亚辉，乔  辉   

  1. 郑州人民医院麻醉科，河南省郑州市  450000
  • 收稿日期:2011-01-29 修回日期:2011-03-05 出版日期:2011-07-30 发布日期:2011-07-30
  • 作者简介:张彩琴，女，1963年生，河南省禹州市人，汉族，1988新乡医学院大学毕业，主治医师，主要从事临床麻醉学研究。 812708928@qq.com

Safety of combined spinal-epidural anesthesia during kidney transplantation in patients with uremia and heart failure

Zhang Cai-qin, Wu Ya-hui, Qiao Hui   

  1. Department of Anesthesiology, Zhengzhou People’s Hospital, Zhengzhou   45000, Henan Province, China
  • Received:2011-01-29 Revised:2011-03-05 Online:2011-07-30 Published:2011-07-30
  • About author:Zhang Cai-qin, Anesthesiology physician, Department of Anesthesia, Zhengzhou People’s Hospital, Zhengzhou 45000, Henan Province, China 812708928@qq.com

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283

被引次数

6

摘要：

背景：尿毒症合并心力衰竭不是肾移植的禁忌证，但此时麻醉管理比较困难。
目的：观察腰-硬联合麻醉用于尿毒症合并急性左心衰竭肾移植时的安全性。
方法：采用腰-硬联合阻滞麻醉为16例合并心力衰竭的患者实施同种异体的尸体肾移植，观察患者腰麻前、腰麻后10 min、移植肾再灌注前、移植肾再灌注后、移植结束时5个时点的收缩压、舒张压、心率和脉搏血氧饱和度变化。
结果与结论：与麻醉前相比，腰麻后10 min患者收缩压、舒张压、心率显著降低(P < 0.05)，心力衰竭症状明显减轻。移植开始后到移植肾再灌注期间，血流动力学稳定，心衰症状基本缓解。与腰麻后10 min、移植肾再灌注前相比，移植肾再灌注后血压明显降低、心率轻度增快(P < 0.05)。移植肾再灌注后到移植结束，血流动力学较为稳定，患者心力衰竭症状完全缓解。16例患者均平稳渡过麻醉期。提示腰-硬联合麻醉用于急性左心衰竭患者的肾移植，把握好腰麻药的给药量和注入速度，不仅术中麻醉效果好、肌松满意，而且能降低心脏后负荷，改善心肺功能，保持血流动力学稳定，不影响移植肾的血液灌注。

关键词: 腰-硬联合麻醉, 肾移植, 心衰, 尿毒症, 安全

Abstract:

BACKGROUND: Uremia combined with heart failure is not the contraindication of kidney transplantation, but anesthesia management is very difficult.
OBJECTIVE: To investigate the safety of combined spinal-epidural anesthesia during kidney transplantation in patients with uremia and heart failure.
METHODS: Under combined spinal-epidural anesthesia, 16 patients with heart failure underwent allogenic corpse kidney transplantation. Before and 10 minutes after anesthesia, before and after reperfusion of kidney transplant, and after kidney transplantation, systolic pressure, diastolic pressure, heart rate, and saturation of blood oxygen were determined.
RESULTS AND CONCLUSION: Compared with prior to anesthesia, systolic pressure, diastolic pressure and heart rate were significantly decreased (P < 0.05) and heart failure symptoms were obviously alleviated at 10 minutes after anesthesia. During the time period from transplantation initiation to transplantation termination, hemodynamical changes were stable, and patients’ heart failure symptoms were completely relieved. All 16 patients were safe during the period of anesthesia. These findings suggest that combined spinal-epidural anesthesia for kidney transplantation in patients with acute left heart failure can produce good anesthetic effects if anesthetic dose and administration speed are proper; in addition, it also can decrease cardiac afterload, improve heart and lung function, and maintain stable hemodynamics, without influence on blood perfusion of kidney transplant.

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