老龄肾移植术患者硬膜外麻醉时的围术期管理  

Management of elderly patients with kidney transplantation at perioperative period undergoing epidural anesthesia

作　　者：刘冀湘[1] 康健[1] 

机构地区：[1]广东省东莞市太平人民医院麻醉科,523900

出　　处：《河北医药》2006年第3期180-181,共2页Hebei Medical Journal

摘　　要：目的研究硬膜外麻醉下老龄肾移植患者围术期血液动力学的变化以及对移植肾早期功能的影响。方法65～81岁老龄肾移植患者（老龄组）54例，硬膜外麻醉，阻滞平面控制在B7±1，并与同期肾移植手术其他年龄组（对照组）50例对比观察。结果与对照组比较，老龄组术中液体治疗量和局麻药用量小（P〈0．05），舒张压（DBP）在T1～T6降低，差异非常显著（P〈0．01）；平均动脉压（MAP）在T4～T6降低，差异显著（P〈0．05），放置容量性肺动脉导管24例中，容量超标者22例（91．7％）；34例（62．9％）需用血管活性药（多巴胺、多巴酚丁胺、去甲肾上腺素），与对照组11例（22．0％）比较差异显著（P〈0．05）。移植肾功能延迟恢复（DGF）和急性肾小管坏死（ATN）两组相比差异无显著性。结论老龄患者肾移植用硬膜外麻醉时，只要加强围术期的监测，必要时用容量性肺动脉导管指导容量治疗，围绕血压、心肺功能调控，致力改善患者的内环境，仍能较好地维护移植肾功能。Objective To investigate the change of hemodynanfics and the effect on renal function by epidural anesthesia in elderly patients with kidney transplantation at perioperative period.Methods 54 patients （the older group,age range 65 - 81 yr） undergoing kidney transplantation were studled.As compared with other 50 patients in control group. The block plane was maintained at T7 ±1 .Results The amount of liquid treatment and local anesthesia drug in the older group was significantly lower than that of control group （ P 〈 0.05）. There was a significant difference in DBP at T1 - T6 between two groups （ P 〈 0.01 ）. There was a significant decrease in MAP at T4 - T6 between two groups （ P 〈0.05）.34 patients （62.9%） in the older group had to be used with vaso-acfive drugs （norepinephfine or dopamine）,which was significantly different from 11 patients （22.0%） in contrast group （ P 〈 0.05）.There was no significant difference in DGF and ATN between the two groups （ P 〈0.05）.Conclusion The careful management for elder patients with kidney transplantation at perioperative period undergoing epidural anesthesia plays an important role, which could improve grafted kidney function.

关 键 词：老年人 麻醉 硬膜外 肾移植 

分 类 号：R614.42[医药卫生—麻醉学] R699.2[医药卫生—外科学]