左旋布比卡因蛛网膜下腔阻滞对老年患者心血管功能的影响  

The hemodynamic changes after levobupivacaine spinal anesthesia in elderly patients

作　　者：郑彬[1] 佘守章[1] 罗卓鹏[2] 何景光[2] 柳建华[2] 

机构地区：[1]广州医学院附属市一人民医院麻醉科,广州510180 [2]广州医学院附属市一人民医院心功能室,广州510180

出　　处：《广东医学》2006年第11期1611-1613,共3页Guangdong Medical Journal

摘　　要：目的 研究左旋布比卡因蛛网膜下腔阻滞对老年患者心血管功能的影响。方法 30例择期下肢或下腹部手术患者（ASAⅠ～Ⅱ级），按年龄的不同分为老年组（≥65岁）和中青年组（〈60岁），每组15例，分别接受0．5％左旋布比卡因15mg蛛网膜下腔阻滞。监测患者心电图（ECG）、血压（MAP）、心率（rm）、脉搏血氧饱和度（SpO2），并应用彩色多普勒超声诊断仪测量左室收缩／舒张末期内径（Dd／Ds）等数据以计算心输出量（CO）、每搏量（SV）、每搏指数（SI）、心脏指数（CI）、射血分数（EF）、外周血管阻力（SVR）等血流动力学参数，记录时点分别为：注药前（T0）、注药后6min（Wa）、12min（T2）和18min（T3）。记录感觉阻滞平面、双下肢运动阻滞情况。结果 老年组T1，T2，T3时点与T0相比，HR，MAP，LVEDV，SV，CO，SVR，SI，CI均有明显下降（P〈0．05和0．01），中青年组SI，LVEDV，SV，SVR，MAP有不同程度的下降（P〈0．05和O．01），CO，CI轻微下降（P〉0．05），HR无明显变化；两组EF变化均无统计学意义。组间比较，老年组变化更为显著（P〈0．05和0．01）。结论 左旋布比卡因蛛网膜下腔阻滞时，老年患者循环功能可受到抑制，主要表现为外周阻力降低、心输出量减少和血压下降，且比中青年组明显，虽然血压的下降仍在正常范围，但仍应密切关注并及时处理。Objective To study the hemodynamic changes after levobupivacaine spinal anesthesia with thansthoracic echocardiography in elderly patients. Methods Thirty patients （ASA Ⅰ～Ⅱ ）undergoing elective surgery on the lower limbs or lower abdomen were divided into elderly group（ age≥ 65years）and control group（ age 〈 60years）. Spinal block was performed with 15 mg of 0.5 % levobupivacaine, The anesthetic management was standardized for all patients and the titans - thoracic echocardiography was used to calculate the cardiac output（CO）, stroke volume（SV）, cardiac index（CI） and eject fraction（EF）. These parameters were recorded before spinal blocking （T0） and 6 min（T1 ）, 12 min（T2）, 18 min（T3）after blocking. The level of sensory block and Bromage score were recorded at the same time. Results Compared with corresponding parameters at T0, HR, MAP, LVEDV, SV, CO, SVR, SI and CI significantly decreased in elderly group at T1, T2 and T3 （P 〈 0.05 and 〈 0.01 ）. In the control group, MAP,LVEDV,SV,SVR,SI also significantly decreased （ P 〈 0.05 and P 〈 0.01）. CO, CI decreased during the study period without significance. EF remained stable in beth groups. Conclusion Levobupivacaine spinal anesthesia in elderly patients can lower blood pressure, cardiac output and peripheral resistance. Measures should be taken to prevent hemodynamic changes before blocking.

关 键 词：麻醉 脊髓 左旋布比卡因 血流动力学 超声检查 

分 类 号：R614.4[医药卫生—麻醉学]