老年冠心病患者非心脏手术麻醉管理方法对术中、术后并发症的影响  

Effects of anesthetic management method on intraoperative and postoperative complications in elderly patients with coronary heart disease undergoing noncardiac surgery

作　　者：高磊 邢珍[2] GAO Lei;XING Zhen(Hebei North College,Hebei,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院,河北省张家口市075000 [2]河北北方学院附属第一医院麻醉科

出　　处：《河北医药》2018年第23期3554-3557,3561,共5页Hebei Medical Journal

摘　　要：目的探讨如何通过精准的围术期麻醉管理,减少老年冠心病患者非心脏手术术中、术后并发症的发生。方法择期行下腹部手术的老年冠心病患者67例,平均年龄(72. 49±5. 45)岁,体重指数18. 5～23. 9 kg/m2,ASA分级Ⅱ或Ⅲ级。将患者随机分为腰硬联合麻醉组(CSEA组) 21例,全身麻醉组(GA组) 23例,硬全联合麻醉组(GECA组) 23例。记录全身麻醉组、硬全联合麻醉组患者入室后(T0)、插管前(T1)、插管后3 min(T2)、插管后5 min(T3)及切皮后即刻(T4)、手术开始后30 min(T5)、手术结束时(T6)的平均动脉压(MAP)、心率(HR)和血氧饱和度(SPO_2),腰硬联合麻醉组患者入室后(T0)、麻醉开始前(T1)、注药后3 min(T2)、注药后5 min(T3)及切皮后即刻(T4)、手术开始后30 min(T5)、手术结束时(T6)的MAP、HR和SPO_2。同时记录3组患者术中术后出现的各项并发症,术毕时记录手术时间、出血量、尿量及总入量。结果 67例患者术中出现血压大幅波动(超过MAP基线值的20%) 26例,心律失常13例,术后出现肺炎4例,认知功能障碍1例,第5天发生脑梗死1例。血流动力学方面,腰硬联合麻醉组患者T2、T3的MAP、HR显著低于T1(P <0. 05);全身麻醉组T2、T3的MAP、HR显著高于T1(P <0. 05);硬全联合麻醉组各时间节点MAP、HR与T1比较差异无统计学意义(P> 0. 05)。结论老年冠心病患者行非心脏手术,接受硬全联合麻醉患者血流动力学较为稳定、术中心律失常与心血管并发症的发生率较低。术后并发症的发生受多种因素的影响,术前全面的风险评估及术中精准的麻醉管理有助于减少术后并发症的发生。Objective To explore how to reduce the incidence of intraoperative and postoperative complications in elderly patients with coronary heart disease undergoing noncardiac surgery through precise perioprative anesthetic management.Methods A total of 67 elderly patients with coronary heart disease who were scheduled for lower abdominal surgery,with average age of(72.49±5.45)yr,body mass index ranged from 18.5~23.9kg/m 2,and ASA physicalstatusⅡorⅢ,were enroled in the study.The patients were randomly divided into three groups:combined spinal and epidural anesthesia group(CSEA group,n=21),general anesthesia group(GA group,n=23),combined anesthesia group(GECA group,n=23).The levels of MAP,HR and SPO 2 were recorded in GA group and GECA group at different time points including after admission of the OR(T0),before intubation(T1),3min after intubation(T2),5min after intubation(T3),immediately after the skin cutting(T4),30mins after the start of the operation(T5)and the end of the operation(T6).However in CSEA group,the levels of MAP,HR and SPO 2 were recorded at the following time points:after admission of the OR(T0),before anesthesia(T1),3min after injection(T2),5min after injection(T3),immediately after the skin cutting(T4),30min after the start of the operation(T5)and at the end of operation(T6).The intraoperative and postoperative complications,operation time,intraoperative bleeding volume,urine volume and fluid infusion were observed and compared among the three groups.Results Among the 57 patients,there were 26 cases of great fluctuation of blood pressure(over 20%of the MAP baseline value)and 13 cases of arrhythmia,4 cases of postoperative pneumonia,1 case of postoperative cognitive dysfunction,1 case of cerebral infarction occurred at 5 days after surgery.In the aspect of hemodynamics,the levels of MAP and HR at T2 and T3 in CSEA group were significantly lower than those at T1(P<0.05),however,the levels of MAP and HR at T2 and T3 in GA group were significantly higher than those at T1(P<0.05).There were no signif

关 键 词：老年 冠心病 非心脏手术 麻醉管理方法 并发症 

分 类 号：R614[医药卫生—麻醉学]