硬膜外麻醉和腰麻对老年患者区域脑氧饱和度的影响  

Effect of Epidural Anesthesia and Spinal Anesthesia on Regional Cerebral Oxygen Saturation in Elderly Patients

作　　者：杜金广[1] 张涤非[2] 张运淳[1] 朱琳琳[1] 韦鹏[1] 梅枚[1] 

机构地区：[1]蚌埠医学院第一附属医院麻醉科,安徽省蚌埠市233004 [2]安徽省太和县医院麻醉科

出　　处：《中华全科医学》2013年第1期27-28,共2页Chinese Journal of General Practice

摘　　要：目的评估硬膜外麻醉和腰麻对区域脑氧饱和度(rSO2)的影响。方法将准备择期行股骨头置换的82名65岁以上、ASA(American Society of Anesthesiologists physical status)Ⅰ～Ⅱ级和经过严格术前准备的Ⅲ级的患者前瞻、随机的分为两组,分别接受蛛网膜下腔麻醉(SA)和硬膜外麻醉(EA)。观察所有患者在麻醉前、中、后不同时段的rSO2、平均动脉压(MAP)、心率(HR)、外周脉搏氧饱和度(SpO2)的异常值频数和术后24 h内谵妄的发生例数。结果 SA组rSO2低于基础值的发生频率明显高于EA组。然而在两组间,低于基础值的患者数没有区别。同时谵妄的发生没有差异。多元回归分析发现,在两种麻醉方法中患者的血压、心率和外周氧饱和度异常值频数以及谵妄发生数与rSO2低于基础值的频率没有相关性。结论蛛网膜下腔麻醉对老年患者的区域脑氧饱和度的影响可能比硬脊膜外大。Objective To assess the effect of spinal anesthesia and epidural anesthesia on the regional cerebral oxygen satu- ration （ rSO2 ）. Methods Eighty-two geriatric patients （65y or more）, meeting American Society of Anesthesiologists physical sta- tus I,II or III,undergoing femoral head replacement,were randomly divided into two groups（ n =41 ） ：EA group and SA group. In all cases,the number of abnormal value of frontal rSO2 ,mean arterial pressure（MAP） ,heart rate（HR） ,SpO2 and the case of de- lirium at different time point of before, during and after anesthesia were measured postoperatively. Results The frequency of a decrease in rSO2 below baseline preoperative levels was significantly higher in group SA （ P 〈 0.05 ）. However, the number of pa- tients in whom at least one dip below baseline was recorded was similar between the groups. Logistic regression revealed no corre- lation between changes in blood pressure, heart rate, peripheral oxygen saturation, the incidence of delirium and the frequency of rSO2 dips below baseline. Conclusion The impact of SA on regional cerebral oxygen saturation is likely more obvious than EA in elderly patients.

关 键 词：硬脊膜外麻醉 蛛网膜下腔麻醉 近红外线光谱仪 区域脑氧饱和度 股骨头置换术 

分 类 号：R614.42[医药卫生—麻醉学] R614.4[医药卫生—外科学]