Does epidural anesthesia have protective effect on hemorrhagic shock?

硬膜外麻醉对失血性休克有保护作用吗？

• 批准号: 02807146
• 负责人: TAKASAKI Mayumi
• 金额: $ 0.96万
• 依托单位: Miyazaki Medical College
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (C)
• 财政年份: 1990
• 资助国家: 日本
• 起止时间: 1990 至 1991
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-02807146/
• 关键词: Epidural anesthesia; Hemorrhagic shock; Catecholamine; 内分泌動態

Background: The beneficial effects of thoracic epidural anesthesia on survival and physiologic functions during hemorrhagic shock have been shown in animals but have not been supported universally. This study was designed to clarify differences between epidural and halothane anesthesia and between upper thoracic and thoracolumbar epidural anesthesia in hemodynamic and metabolic responses to hemorrhage in dogs. Methods: Group 1 of seven dogs received 0.2% halothane anesthesia, group 2 of six received 0.2% halothane plus epidural anesthesia ranged from C_4 to T_5, group 3 of seven received 0.2% halothane plus epidural anesthesia ranged from C_5 to L_7, and group 4 of eight received 0.9% halothane anesthesia. After blood removal (35 ml・kg^<-1>) for 30 min, hemodynamic, metabolic and catecholamine variables were measured repeatedly at 30-min intervals for 2h.Results: Two dogs in group 1 died 1 h after hemorrhage but all dogs in the other groups survived. The mean arterial pressure, pulmona … More ry capillary wedge pressure, central venous pressure and cardiac output decreased significantly in all groups. However, the decrease in mean arterial pressure was significantly larger in group 3 than in groups 1,2 and 4. The heart rate increased significantly rapidly in group 1 and slowly in group 4, but decreased significantly in group 3. In group 2, it remained unchanged. Arterial pH and base excess decreased significantly in all groups. After that, base excess recovered slowly in groups 2 and 4 but decreased further in groups 1 and 3. The plasma epinephrine concentration increased significantly and stayed at higher level in group 1. In groups 2 and 4, it also increased but decreased slowly. In group 3, it remained unchanged. The plasma norepinephrine concentration increased significantly markedly in group 1. In groups 2 and 4, it increased moderately. In group 3, it remained unchanged. The hemodynamic, metabolic and catecholamine variables during hemorrhagic shock were maintained better in groups 2 and 4 than in groups 1 and 3 in the single-withdrawal hemorrhagic models.Conclusions: The hemodynamic, metabolic and catecholamine responses to hemorrhagic shock under upper thoracic epidural anesthesia were similar to those under 1 MAC halothane anesthesia. However, widespread epidural anesthsia or light halothane anesthesia worsened the hemodynamic and metabolic parameters during hemorrhagic shock. Less

背景资料：胸段硬膜外麻醉对失血性休克动物的生存和生理功能的有益作用已被证实，但尚未得到普遍支持。本研究旨在阐明硬膜外麻醉和氟烷麻醉以及上胸段和胸腰段硬膜外麻醉对犬出血的血流动力学和代谢反应的差异。研究方法：第1组7只，采用0.2%氟烷麻醉;第2组6只，采用0.2%氟烷+硬膜外麻醉，麻醉范围为C_4 ~ T_5;第3组7只，采用0.2%氟烷+硬膜外麻醉，麻醉范围为C_5 ~ L_7;结果<-1>：实验1组2只犬于失血后1h死亡，其余各组犬均存活。平均动脉压，肺动脉压 ...更多信息 各组毛细血管楔压、中心静脉压和心输出量均显著降低。然而，第3组的平均动脉压下降幅度明显大于第1、2和4组。心率在第1组显著快速增加，在第4组缓慢增加，但在第3组显著降低。第二组保持不变。所有组的动脉pH值和碱过剩均显著降低。之后，第2组和第4组的碱过量缓慢恢复，但第1组和第3组进一步降低。第1组血浆肾上腺素浓度显著升高并维持在较高水平。在第2和第4组，它也增加，但下降缓慢。第三组保持不变。第1组血浆去甲肾上腺素浓度显著升高。在第2组和第4组中，它适度增加。第三组保持不变。结论：上胸段硬膜外麻醉对失血性休克的血流动力学、代谢和儿茶酚胺的反应与1 MAC氟烷麻醉相似。然而，广泛硬膜外麻醉或轻度氟烷麻醉使失血性休克时血流动力学和代谢参数恶化。少

项目成果

Agune T, Yoshikawa G and Takasaki M: "Effects of epidural analgesia on circulatory, metabolic and endocrine responses to hypovolemic shock in dogs." Masui. 41-Suppl.S678 (1992)

Agune T、Yoshikawa G 和 Takasaki M：“硬膜外镇痛对狗低血容量休克的循环、代谢和内分泌反应的影响。”

義川 剛太郎: "硬膜外麻酔と全身麻酔のどちらが出血性ショックに有利か" 麻酔. 40. (1991)

Gotaro Yoshikawa：“对于失血性休克，硬膜外麻醉或全身麻醉哪个更好？”40。（1991）

莫根 正: "出血性ショック時の循環と代謝内分泌動態に及ぼす硬膜外麻酔の影響" 麻酔. 41. (1992)

Tadashi Mokon：“硬膜外麻醉对失血性休克期间循环和代谢内分泌动态的影响”麻醉41。