不同麻醉方法对行单侧下肢手术老年冠心病患者术后影响研究  

Post-operative influence of different anesthesia methods on the elderly patients with coronary heart disease undergoing unilateral lower extremity surgery

作　　者：叶建荣[1] 俞瑾[1] 郑宏[1] 陈林[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐市830054

出　　处：《中华实用诊断与治疗杂志》2011年第5期446-448,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：新疆维吾尔自治区科技支疆项目(200991126);新疆维吾尔自治区重点学科(内科学)建设经费(2004-2008)

摘　　要：目的:评价3种麻醉方法对行单侧下肢手术老年冠心病患者的术后影响。方法:择期行单侧下肢手术老年冠心病患者65例,随机分为神经阻滞组(N组)21例,硬膜外麻醉组(E组)25例和全身麻醉组(G组)19例。N组采用神经刺激仪定位下的腰丛联合坐骨神经阻滞;E组采用L2-3间隙连续硬膜外麻醉;G组采用咪唑安定-芬太尼-维库溴铵麻醉诱导,丙泊酚麻醉维持。观察并记录各组术后3 d心电图ST-T变化和心脏不良事件发生率,术后3 d肌钙蛋白Ⅰ水平,术后24,48,72 h静息及运动后VAS评分。结果:术后第1天G组肌钙蛋白Ⅰ水平较N组增高(P<0.05),术后第3天E、G组均较N组增高(P<0.05)。术后第1天G组心电图ST-T改变较E、N组明显(P<0.05)。术后3 d高血压发生率G组较E、N组高(P<0.05),且主要发生在术后第1天。G组术后24,48,72 h静息状态下VAS评分高于E、N组(P<0.05);G组术后24,72 h运动状态下VAS评分高于E、N组(P<0.05)。结论:神经刺激仪引导下外周神经阻滞可达到理想麻醉效果,且术后VAS评分与连续硬膜外麻醉相近,术后心电图ST-T影响小,心肌损害较小。Objective To evaluate and analyze three anesthesia methods in the elderly patients with coronary heart disease undergoing unilateral lower extremity surgery.Methods Sixty-five elderly patients with coronary heart disease undergoing unilateral lower extremity surgery were randomly divided into three groups： group N receiving nerve stimulator guided lumbar plexus plus sciatic nerve（n=21）,group G receiving induction anesthetic with vecuronium,midazolam and fentanyl followed by maintenance anesthesia with propofol（n=19）,and group E receiving epidural anesthesia in L2-3 epidural space（n=25）.All patients were observed and recorded the ECG ST-T changes,the major adverse cardiac events,troponin Ⅰ changes three days after surgery,and resting/postexercise VAS scores in postoperative 24,48 and 72 hours.Results Post-operative troponin Ⅰwas significantly lower in group N than that in group G（P0.05） on the first postoperative day,and than that in group E and group G on the third postoperative day（P0.05）.The ECG ST-T changes were more obvious in group G than those in group N and group E on the first postoperative day（P0.05）.The incidence of the hypertension was higher in group G than that in group N and group E in postoperative three days（P0.05）,and mainly occurred on the first day（P0.05）.VAS scores were higher in quiescent condition in 24,48 and 72 hours,and in post-exercise condition in 24 and 72 hours in group G than those in group E and N.Conclusion The nerve stimulator guided nerve block has a satisfactory anesthesia effect.VAS score is not significantly different from that of epidural anesthesia.It has a slight influence on ECG ST-T and almost does not injure the myocardium.

关 键 词：麻醉方法 冠心病 单侧下肢手术 老年 

分 类 号：R614[医药卫生—麻醉学]