不同麻醉方式对高龄患者下肢手术血流动力学的影响  

Influence of Different Anesthetic Methods on Haemodynamics in the Elderly Patients Undergoing Lower Extremity Surgery

作　　者：黄建辉[1] 谢长春[1] 付建强[1] 钟启钊[1] 钟琳[1] 蔡瑞卿[1] 

机构地区：[1]广州医学院荔湾医院麻醉科,广东广州510170

出　　处：《临床医学工程》2012年第7期1070-1072,共3页Clinical Medicine & Engineering

基　　金：广州市荔湾区科技计划项目(20101212207)

摘　　要：目的比较轻比重腰-硬联合阻滞、硬膜外阻滞及静脉复合全身麻醉对行下肢手术高龄患者血流动力学的影响。方法 60例80～95岁择期下肢手术患者随机分为三组,每组20例,分别采用轻比重腰麻-硬膜外联合阻滞(SE组)、连续硬膜外阻滞(E组)、气管插管静脉复合全身麻醉(G组),监测心率(HR)、血压(MAP),并利用胸腔生物电阻抗技术监测患者每搏指数(SVI)、心输出量(CO)、心脏指数(CI)、全身外周血管阻力(SVR)等血流动力学指标,记录时点为:麻醉前(T0)、麻醉后5min(T1)、15min(T2)、30min(T3)、60min(T4)及术毕(T5)。结果与T0比,MAP、SVI、CO、CI及SVR各指标G组在T1和T2、E组在T2～T5各时点均有明显下降(P<0.05和0.01);SE组MAP、CO及CI在各时点仅有轻微下降,差异无统计学意义(P>0.05)。结论轻比重布比卡因腰-硬联合麻醉用于高龄患者下肢手术阻滞范围小,血流动力学相对稳定。Objective To compare the influence of combined spinal epidural anesthesia,epidural anesthesia and general anesthesia on haemodynamics in the elderly patients undergoing lower extremity surgery.Methods 60 patients aged 80~95 scheduled for selective lower extremity surgery were randomly divided into three groups.Group SE anesthetized with spinal-epidural anesthesia,group E anesthetized with epidural anesthesia,group G anesthetized with general anesthesia.HR,MAP and hamodynamic parameters（including SVI,CO,CI,SVR） were monitored and recorded by impedance cardiography before anesthesia（T0）,5 min（T1）,15 min（T2）,30 min（T3）,60 min（T4） after anesthesia and at the end of surgery（T5）.Results Compared with T0,MAP,SVI,CO,CI and SVR significantly decreased at T1,T2 in group G and at T2 ~ T5 in group E（P 0.05 and 0.01）.MAP,CO and CI decreased during the study period without significance in group SE（P 0.05）.Conclusions Hypobaric bupivacaine spinal-epidural anesthesia allows minimizing the extent of blockade and maintaining the hemodynamic stability in the elderly patients undergoing lower extremity surgery.

关 键 词：腰-硬联合阻滞 硬膜外阻滞 全身麻醉 老年人 血流动力学 

分 类 号：R614[医药卫生—麻醉学]