目的 探讨阻塞性黄疸患者在七氟醚吸入麻醉过程中血流动力学的变化.方法 择期手术患者80例,ASA Ⅰ或Ⅱ级,按照血清总胆红素(sTBL)水平分为观察组(A组,sTBL≥17.1μmol/L)和对照组(B组,sTBL<17.1 μmol/L),每组40例.分别在麻醉诱导前、呼出气七氟醚浓度在1.0 MAC和1.5 MAC并维持10 min时记录血流动力学指标.结果 麻醉诱导前A组MAP、HR、全身血管阻力(SVR)、心脏指数(CI)、肺毛细血管楔压(PCWP)明显低于B组(P<0.05或P<0.01).1.0 MAC时A组MAP、平均肺动脉压(MPAP)、CI、每搏指数(SI)的下降百分率均明显大于B组(P<0.05或P<0.01).1.5MAC时A组患者MPAP、MAP、CI的下降百分率明显大于B组(P<0.05或P<0.01).结论 与非阻塞性黄疸患者比较,阻塞性黄疸患者血流动力学随七氟醚呼出气浓度增加而波动增大.%Objective To investigate the hemodynamic characters of patients with obstructive jaundice during sevoflurane anesthesia. Methods The hemodynamic parameters were recorded in 40 patients (group A) with obstructive jaundice (serum total bilirubin≥17.1 μmol/L) before(T1) and during sevoflurane anesthesia at the expiratory concentrations of 1.0 MAC(T2) and 1.5 MAC(T3), which were compared with those in 40 patients (group B) without jaundice(serum total bilirubin< 17.1 μmol/L). Results Mean arterial pressure(MAP), heart rate(HR), systemic vascular resistance (SVR), cardiac index(CI), pulmonary capillary wedge pressure(PCWP) in group A were significantly lower than those in group B at T1 (P<0.05 or P<0.01). The percentage of decrease in MAP,mean pulmonary arterial pressure(MPAP), strock index(SI) and CI at T2 was significantly greater in group A than that in group B (P<0. 05 or P<0.01). So did the MPAP,MAP and CI at T3(P<0.05 or P <0.01). Conclusion Compared with the patients without obstructive jaundice, the hemodynamics during sevofiurane anesthesia in the patients with obstructive jaundice is concentration-dependently changed much severely.
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