高龄心脏病患者非心脏手术麻醉管理经验  

Anesthesia management for geriatric patients with previous heart diseases undergoing noncardiac surgery

作　　者：李秋霞[1] 卢家凯[1] 卿恩明[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科,100029

出　　处：《心肺血管病杂志》2009年第3期156-158,共3页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:总结合并心血管疾病的高龄患者行非心脏手术麻醉管理的经验,提高麻醉管理质量。方法:回顾性分析189例年龄70～101岁,平均(77.5±6.3)岁,合并心血管疾病患者行非心脏手术的麻醉管理资料。总结麻醉方法、药物应用、监测和围术期不良事件的预防及处理措施。结果:71例行下肢和下腹部手术患者选择硬膜外麻醉,首次剂量1%利多卡因6～8mL;其余为全身麻醉;全身麻醉在诱导时容易发生血压波动,急诊手术患者更明显。全组患者术前穿刺动、静脉监测,72%患者术中应用硝酸甘油治疗,34例患者术中应用多巴胺,63例心律失常者应用胺碘酮或艾司洛尔。麻醉期无死亡病例,1例患者术后2d死于急性心肌梗死。结论:重视术前准备和术中监测;硬膜外麻醉选择低浓度、小容量多次给药方法;全麻诱导药应用缓慢给药、延长诱导时间方法;维持术中循环稳定,积极改善冠状动脉供血,心功能较差者适当应用强心利尿药。Objective：To analyze the experience of the anesthetic management for noncardiac surgery in the geriatric patients with previous heart disease and improve the quality of related anesthesia management. Method： A retrospective study was carried out in 189 patients who underwent noncardiac surgery. All of them are over 70 years old and with positive history of cardiovascular diseases. The selection of anesthesia method, intraoperative medications, mornitoring and prophylactic measure for intraoperative cardiovascular events were investigated retrospectively. Result： The incidents of preoperative hypertension and myocardial ischemia in this group were 77 %, 80 % respectively. Hemodynamic fluctuation were common in anesthesia induction episode, especially in emergency cases. Introperative of coronary artery dilators, inotropic agents and anti-arrhythmia medications were applied in 72% ,34%, and 63% cases of this group respectively. There is no death anesthetic procedure. One case died of myocardial infaction within 2 days after surgery. Conclusion： Effective preoperative preparation and intraoperative monitoring are important. Epidural anesthesia with low concentration and low volume of local anesthetics is applied ; while general anesthesia should induced with intravenous anesthetics at low dose, prolonging induction time. active maintenance of myocardial oxygen supply / consumption balance is key points in elderly patients.

关 键 词：麻醉管理 高龄 心血管疾病 非心脏手术 

分 类 号：R54[医药卫生—心血管疾病]