直立性低血压老年人在硬膜外麻醉期间低血压的临床分析  

Clinical Analysis of Hypotension of Elderly with Orthostatic Hypotension During Epidural Anesthesia

作　　者：曹德雄[1] 曹林[1] 江慧琦[1] 徐忠东[1] 王飞[1] 

机构地区：[1]中山大学附属第二医院麻醉科,510120

出　　处：《岭南急诊医学杂志》2010年第4期315-316,318,共3页Lingnan Journal of Emergency Medicine

摘　　要：目的:研究直立性低血压的老年人在硬膜外麻醉期间低血压的发生率及血流动力学的变化,初步探讨其血压变化的机制。方法:将70例拟行下腹部手术的老年人分为直立性低血压组(Ⅰ组)19例和对照组(Ⅱ组)51例。观察两组病人在行硬膜外麻醉后(阻滞平面控制在胸6以下)低血压的发生率;比较两组病人在麻醉前及低血压发生时的中心静脉压(CVP)、心输出量(CO)、总外周阻力(TPR)及心率(HR)。结果:硬膜外麻醉后,Ⅰ组低血压发生率(100%)比Ⅱ组(71%)高(P<0.01);低血压发生时,与麻醉前比较,两组病人均见CO降低(Ⅰ组P<0.01,Ⅱ组P<0.05)及CVP下降(Ⅰ组P<0.001,Ⅱ组P<O.01);且Ⅰ组CO和CVP的降低更为明显(P<0.01)。结论:直立性低血压老年人在硬膜外麻醉期间更易于出现低血压,其主要原因可能与直立性低血压老年人CO的减少更为剧烈有关。Objective： To investigate the incidence of hypotension and hemodynamic changes of the elderly with orthostatic hypotension during epidural anesthesia and to explore the mechanism of blood pressure change. Methods： 70 old cases undergoing lower abdominal operations were divided into orthostatic hypotension group （ Ⅰ group, tt=19） and control group （ Ⅱ group,n=51）. Low blood pressure occurrence was observed after epidnral anesthesia （blockade level was limited below the sixth thoracic vertebra） in the two groups. Central venous pressure （CVP）, cardiac output （CO）, total peripheral resistance （TPR） and heart rate （HR） were compared before anesthesia and at the occurrence of low blood pressure between the two groups. Results： After epidural anesthesia, the incidence of hypotension in Ⅰ group was higher than that in Ⅱ group （P〈0.01）. In both I group and H group, when hypotension occurred, CO and CVP decreased as compared with pre-anesthesia （P〈0.01）. However, CO and CVP reduced more remarkably in Ⅰ group than that in Ⅱ group （P〈0.01）. Conclusions： During epidural anesthesia, the elderly with orthostatic hypotension are more prone to suffering from hypotension as compared with normal subjects, probably due to more dramatic CO reduction in the elderly with orthostatic hypotension.

关 键 词：直立性低血压 硬膜外麻醉 血流动力学 

分 类 号：R614[医药卫生—麻醉学]